Increased Risk of Venous Thromboembolism Following Posterior Versus Anterior Cervical Spine Fusion: A Propensity-Matched Cohort Study

Study DesignPropensity-matched retrospective cohort study.ObjectiveThis study aimed to compare the incidence of venous thromboembolism (VTE) complications following posterior cervical decompression and fusion (PCDF) and anterior cervical discectomy and fusion (ACDF).MethodsThe TriNetX database was queried for patients >18 years old undergoing single- or multi-level ACDF or PCDF between 2004 and 2024. Patients with prior VTE, thrombophilia, or prior cervical spine surgery were excluded. Propensity score matching was performed using demographics, comorbidities, and anticoagulation use. Primary outcomes included 30- and 90-day incidence of VTE events and post-operative bleeding complications. Differences between PCDF and ACDF were reported as odds ratios with 95% confidence intervals (CI).ResultsThere were 4381 patients included in each single-level cohort and 15 577 patients in each multi-level cohort. Compared to single-level ACDF, single-level PCDF was associated with higher odds of VTE events at 30-days (OR: 1.96, 95% CI: 1.28-2.94; <i>P</i> = 0.001) and 90-days (OR: 2.05, 95% CI: 1.43-2.94; <i>P</i> < 0.001). Multi-level PCDF was also associated with higher odds of VTE events at 30-days (OR: 3.83, 95% CI: 3.13-4.76; <i>P</i> < 0.001) and 90-days (OR: 3.97, 95% CI: 3.33-4.76; <i>P</i> < 0.001) when compared to multi-level ACDF. There were no significant differences in post-operative bleeding complications (<i>P</i> > 0.05).ConclusionsPCDF was associated with increased VTE complications with no differences in postoperative bleeding events when compared to ACDF. Incorporating surgical approach may enhance VTE risk assessment following cervical spine surgery.