Surgical Outcomes Following Fusion in Patients with Congenital Cervical Spinal Stenosis

Introduction: Cervical spinal stenosis is characterized by an abnormal narrowing of the cervical spinal canal. Patients with congenital cervical spinal stenosis (CCSS), also known as developmental cervical spinal stenosis, are predisposed to increased development of myelopathy from cervical spondylosis. There are no reported data to help determine the surgical outcomes with congenital cervical canal stenosis in comparison to patients with normal cervical spinal canal diameter. Therefore, the objective was to identify the driving forces behind complications and future cervical surgery following spinal fusion in patients with normal cervical canal anatomy and those with CCSS.

Methods: All patients who underwent cervical decompression via an anterior and/or posterior approach for cervical spondylosis with at least one year of follow-up at a large tertiary care center were retrospectively reviewed. CCSS was identified using the Torg-Pavlov ratio (sagittal diameter of the spinal cord divided by the sagittal diameter of the vertebral body) on lateral cervical radiographs. A ratio of < 0.80 met the diagnostic criteria for CCSS. CCSS patients were 1:8 propensity-score matched to non-CCSS patients based upon demographic factors and medical comorbidities. Cox proportional hazard ratio was utilized to analyze the likelihood of future cervical surgery. Chi-square was utilized to analyze differences in postoperative outcomes between cohorts.

Results: After matching, there were 47 CCSS patients and 376 non-CCSS patients. The CCSS cohort had a statistically significant larger average age compared to the non-CCSS cohort. There were no other significant differences between cohorts. CCSS was not a driver for future cervical surgery in the univariate model. Prior cervical surgery was the only driver for future cervical surgery in the univariate (HR: 8.236; 95% CI: 3.649 to 18.592; p = < 0.001) model. There were no significant differences in surgical complications between cohorts.

Conclusion : Patients with CCSS were not more likely to present with complications from decompression or fusion or require additional cervical surgery due to their congenital stenosis. Our findings suggest that in patients with CCSS, equal consideration should be given to surgical intervention.