Revision Rates After Single-Level Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: An Observational Study With 5-Year Minimum Follow-Up.
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引用次数: 0
Abstract
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.
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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.
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