Revision Rates After Single-Level Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: An Observational Study With 5-Year Minimum Follow-Up.

Study design: A retrospective case-control study.

Objectives: This study aimed to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF).

Summary of background data: 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.

Patients and methods: A nationwide database 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 5-year follow-up. Patients undergoing CDA were in a 1:5 ratio matched to patients undergoing ACDF by age, sex, comorbidities, and overall Elixhauser comorbidity index (ECI). Objectives were to compare the rates and risk factors of all-cause 5-year revisions for those undergoing single-level CDA versus ACDF. Multivariate logistic regression models computed the odds ratios (ORs) of revisions within 5 years. P values of less than 0.001 were significant.

Results: A total of 32,953 patients underwent single-level CDA (N=5,640) or ACDF (N=27,313) with a 5-year minimum follow-up. The incidence of all-cause revisions within 5 years was 1.24% for CDA and 9.23% for ACDF ( P <0.001). After adjustment, patients undergoing single-level ACDF had 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 arrhythmias (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 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 regarding 5-year revisions following single-level CDA or ACDF.

Level of evidence: III.