Regional Variations in Surgical Approach and Perioperative Outcomes in Adult Cervical Instrumentation Surgery: A Nationwide Registry Study from the JSIS-DB.

Authors

Shunsuke Katsumi, Hideyuki Arima, Koji Yamada, Mitsuru Yagi, Ryo Mizukoshi, Kimiaki Yokosuka, Junya Katayanagi, Atsushi Tagami, Yusuke Hori, Yukihiro Matsuyama, Hiroshi Taneichi, Tokumi Kanemura, Akira Matsumura, Haruki Ueda

Published in

Spine surgery and related research. Volume 10. Issue 5. Pages 674-684. Sep 27, 2026. Epub Apr 08, 2026.

Abstract

Cervical spinal surgery is performed for various pathologies, including degenerative disease, deformity, trauma, tumor, and infection. However, the surgical approach (anterior vs. posterior) and perioperative safety may vary among regions due to differences in patient characteristics, surgeon experience, and healthcare infrastructure. This study aimed to clarify regional variations in approach selection and perioperative outcomes for cervical surgery in Japan using the nationwide registry of the Japanese Spinal Instrumentation Society Database (JSIS-DB).
This retrospective observational study included adult patients (≥18 years) registered in the JSIS-DB between February 2018 and March 2022 who underwent cervical anterior or posterior fusion surgery. Occipito-cervical and cervico-thoracic fusion procedures were excluded. Patients were classified into 6 geographic regions. Regional differences in patient demographics, surgical characteristics, perioperative outcomes, surgeon experience, and reoperation rates were analyzed using appropriate statistical methods.
A total of 2,581 patients were analyzed. Significant regional variation was observed in patient characteristics, American Society of Anesthesiologists physical status classification, surgical approach, operative time, estimated blood loss, surgical urgency, length of hospital stay, complication rates, and surgeon and assistant experience levels (all p<0.05). Anterior procedures were more frequently performed in the Kanto and Kyushu regions, whereas posterior approaches predominated in other regions. Importantly, no significant regional difference was observed in reoperation rates (p=0.254). Reoperations were infrequent nationwide (5.9% overall) and were primarily related to mechanical or decompressive issues rather than major complications.
This nationwide registry study demonstrated substantial regional variation in surgical strategies and perioperative complication rates in adult cervical surgery in Japan. Despite these differences, reoperation rates remained consistently low and comparable across regions. These findings indicate that while reoperation rates are uniform, perioperative complication profiles vary geographically. This study provides a comprehensive overview of contemporary cervical fusion practice and highlights the need for further research into the factors driving regional variations.

PMID:
42893280
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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