19. Revision rates after single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: an observational study with 5-year minimum follow-up

Abstract

BACKGROUND CONTEXT

Prospective studies have compared patient reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported.

PURPOSE

The aims were to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) or Anterior Cervical Discectomy and Fusion (ACDF).

STUDY DESIGN/SETTING

Retrospective case-control observational study.

PATIENT SAMPLE

A nationwide United States population database from 2010 to 2021 was queried for patients undergoing primary single level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum of 5-year follow-up.

OUTCOME MEASURES

Objectives were to compare the rates of all-cause 5-year revisions for those undergoing single level CDA versus ACDF and assess the risk factors associated with requiring revision surgery.

METHODS

Patients undergoing CDA were 1:5 ratio matched to patients undergoing ACDF by age, sex, individual comorbidities, and overall Elixhauser comorbidity index (ECI). Multivariate logistic regression models were used to calculate odds ratios (OR) of revision surgery within 5 years of the primary procedure while controlling for age, sex, and individual comorbidities comprising the ECI. P values less than 0.001 were significant.

RESULTS

After successful ratio matching, a total of 32,953 patients underwent single level CDA (N=5,640) or ACDF (N=27,313) with 5-Year minimum follow-up. The incidence of all cause revision within 5 years was 1.24% for CDA and 9.23% for ACDF (P<0.001). After adjustment, patients undergoing single level ACDF has significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P<0.0001). Additional patient specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P<0.0001), depression (OR: 1.23; P<0.0001), cardiac arrythmias (OR: 1.21; P=0.0008), hypertension (OR: 1.20; P=0.0006), and tobacco use (OR: 1.18; P=0.0003).

CONCLUSIONS

In this observational study of nearly 33,000 single level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients on nationwide reported revision rates up to 5-years from single level CDA or ACDF.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.