Comparison of ACDF and Corpectomy in Octogenarians with Cervical Epidural Abscess
Overview
This retrospective study compared anterior cervical discectomy and fusion (ACDF) versus corpectomy in octogenarians with ventrally located cervical spinal epidural abscess (CSEA). The analysis focused on early complications, neurological outcomes, and mortality over a two-year follow-up, revealing differences in surgical duration, complication rates, and functional recovery between the two approaches.
Background
Cervical spinal epidural abscess (CSEA) is a rare but severe infection causing rapid neurological decline, especially in elderly patients. Octogenarians are at increased risk due to comorbidities and diminished physiological reserve, complicating diagnosis and treatment. Surgical options include ACDF and corpectomy, with the choice influenced by abscess location and extent of osteomyelitis. However, evidence guiding optimal surgical management in this frail population remains limited.
Data Highlights
Parameter
ACDF Group (n=)
Corpectomy Group (n=)
p-value
Mean Age (years)
82.2 ± 1.7
82.2 ± 1.7
NS
Surgery Duration (minutes)
Shorter
Longer
<0.05
Perioperative Complications
Lower Rate
Higher Rate
<0.05
Hospital Length of Stay
Shorter
Longer
NS
Neurological Improvement (mJOA score)
Significant
Less Pronounced
<0.05
Mortality Rate (2 years)
Lower
Higher
NS
Key Findings
ACDF was associated with shorter operative times compared to corpectomy in octogenarians with ventrally located CSEA.
Patients undergoing ACDF experienced fewer perioperative complications than those receiving corpectomy.
Neurological function, assessed by the modified Japanese Orthopaedic Association (mJOA) score, improved significantly more in the ACDF group.
Hospital length of stay and mortality rates did not differ significantly between the two surgical groups.
Selection of surgical approach was influenced by neurological status, extent of infection, and surgeon preference.
Clinical Implications
In octogenarian patients with ventrally located cervical epidural abscess, ACDF may offer advantages including reduced operative time and lower complication rates while providing better neurological recovery. Careful patient selection and multidisciplinary decision-making remain essential given the frailty and comorbidities in this population. Early surgical intervention combined with targeted antibiotic therapy is critical to optimize outcomes.
Conclusion
This study suggests that ACDF is a viable and potentially preferable surgical option over corpectomy for octogenarians with ventrally located CSEA, balancing surgical risk and functional recovery. Further prospective studies are needed to confirm these findings and guide treatment protocols in this vulnerable cohort.
References
Amadoru et al., 2017 -- Impact of delayed diagnosis on outcomes in spinal infections
Charlson et al., 1987/1994 -- Charlson Comorbidity Index development and validation
Japanese Orthopaedic Association, 1994 -- Modified JOA score for cervical myelopathy
Institutional Ethics Committee, 2021 -- Study approval no. 880/2021
