Incidence of Multiple Revision Cervical Surgeries After Single-Level Anterior Cervical Discectomy and Fusion.

IF 3.5 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2026-02-01 Epub Date: 2025-02-25 DOI:10.1097/BRS.0000000000005317

Wesley M Durand, Amir Human Hoveidaei, Micheal Raad, Rajan Khanna, Amit Jain

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Abstract

Study design: Retrospective analysis using the MarketScan private insurance database from 2010 to 2020.

Objective: Determine the incidence of multiple revision cervical surgeries at 5 years following primary, single-level anterior cervical discectomy and fusion (ACDF) and assess the risk of subsequent revisions after the first and second surgeries.

Background: The rate of revision surgery after ACDF is well-documented, but data on multiple revision surgeries are limited.

Materials and methods: Adult patients 65 years or younger undergoing primary, single-level ACDF were identified. Patients with infectious, traumatic, or neoplastic etiologies were excluded. The primary endpoint was any revision cervical surgery with follow-up ending at 5 years. Kaplan-Meier and Cox proportional hazards regression were used, adjusting for sex, age, Charlson Comorbidity Index, and region.

Results: A total of 42,845 patients undergoing primary, single-level ACDF (P) were included, with a mean age of 48.9 years (SD: 9.0); 52.8% were females. The "first revision" (R1) group included 2374 patients, and the "second revision" (R2) group had 195 patients. The mean revision-free follow-up was significantly different across the P, R1, and R2 groups, though with small absolute differences (P 2.2 yr, R1 2.0 yr, R2 2.0 yr; P < 0.0001). At 5 years postoperatively, the incidence of revision surgery was 10.8% after primary surgery, 24.1% after 1 revision, and 42.5% after 2 revisions. In multivariable Cox regression, the risk of subsequent revision surgery was significantly higher after one revision (HR: 1.6 vs . primary, P < 0.0001) and even more so after 2 revisions (HR: 2.6 vs . primary, P < 0.0001). Interval hazard analysis showed a significantly higher incidence of revision from 2 to 5 years with each subsequent revision (all P < 0.05).

Conclusion: After primary ACDF in patients younger than 65 years, approximately 10% underwent revision at 5 years postoperatively. The occurrence of subsequent revision surgery was higher; >20% after 1 revision, and >40% after 2 revisions, which is critical for patient decision-making.

Level of evidence: Level III.

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单层颈椎前路椎间盘切除和融合术后多次翻修颈椎手术的发生率。

研究设计：利用2010-2020年MarketScan私人保险数据库进行回顾性分析：目的：确定初级单层次 ACDF 术后 5 年内多次颈椎翻修手术的发生率，并评估第一次和第二次手术后的后续翻修风险：背景数据摘要：ACDF术后的翻修手术率已得到充分证实，但关于多次翻修手术的数据却很有限：方法：对年龄小于 65 岁、接受初级单层 ACDF 手术的成人患者进行鉴定。排除了感染性、创伤性或肿瘤性病因的患者。主要终点是随访5年后的任何翻修颈椎手术。采用 Kaplan-Meier 和 Cox 比例危险回归，并对性别、年龄、CCI 和地区进行了调整：共纳入了 42,845 名接受初级单层 ACDF（P）手术的患者，平均年龄为 48.9 岁（SD 9.0）；52.8% 为女性。第一次翻修"（R1）组有 2374 名患者，"第二次翻修"（R2）组有 195 名患者。P组、R1组和R2组的平均无翻修随访时间有显著差异，但绝对差异较小（P组为2.2年，R1组为2.0年，R2组为2.0年）：初级 ACDF 治疗后，20% 的患者经过一次翻修，超过 40% 的患者经过两次翻修，这对患者的决策至关重要：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.