Migraines as a Risk Factor for Many 90-Day Postoperative Complications Following Single-Level Anterior Cervical Diskectomy and Fusion.

Introduction: Anterior cervical diskectomy and fusion (ACDF) is a common spinal surgery for which patient factors may be associated with adverse outcomes. One such potential predisposing risk factor is a history of migraines. The relationship between migraines and postoperative adverse outcomes following ACDF procedures has not been studied. Appreciating such correlations may aid in patient counseling and care pathways.

Methods: Using the 2015-Q3 2022 PearlDiver Mariner161 database, adult patients undergoing single-level ACDF were identified. Patients who underwent concomitant spinal procedures and patients presenting with a spine infection, trauma, or neoplasm were excluded. Four-to-one matching was conducted for patients without versus with history of migraines based on age, sex, and Elixhauser Comorbidity Index.Ninety-day postoperative adverse events were then characterized, including individual and aggregated events, as well as emergency department visits, and compared for the matched populations with multivariate logistic regression analyses. Five-year occurrences of subsequent cervical spine surgeries were compared using a log-rank test and plotted by Kaplan-Meier survival curves.

Results: Of the 326,722 ACDF patients studied, history of migraines was identified for 16,434 (5.03%). After matching, there were 14,774 patients with migraines and 58,820 patients without migraines.Following ACDF surgery, those with a history of migraines had independently higher odds ratios of experiencing most individual 90-day adverse outcomes, as well as any (OR: 2.53), severe (OR: 2.35), and minor (OR: 2.47) adverse events and emergency department visits (OR: 3.42; P < 0.0001). Those with migraines did not have different rates of subsequent cervical spine surgery out to 5 years.

Conclusion: ACDF patients with a history of migraines were found to have higher rates of most 90-day postoperative adverse outcomes assessed. As such, patients with migraines ought to receive supplemental risk counseling and postoperative resource planning when undergoing ACDF surgery. Nonetheless, it was reassuring that 5-year revision surgeries were not significantly different for those with versus without history of migraines.