Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases
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The aim of this study was to analyze rates of perioperative complications and subsequent cervical surgeries in patients treated for cervical degenerative disc disease with anterior cervical discectomy and fusion (ACDF) and those treated with artificial cervical disc arthroplasty (ACDA) for up to 5-year follow-up.
California’s Office of Statewide Health Planning and Development discharge database was analyzed for patients aged 18–65 years undergoing single-level ACDF or ACDA between 2003 and 2010. Medical comorbidities were identified with CMS-Condition Categories. Readmissions for short-term complications of the procedure were identified and rates of subsequent cervical surgeries were calculated at 90-day and 1-, 3-, and 5-year follow-up. Multivariate regression modeling was used to identify associations with complications and subsequent cervical surgeries correcting for patient and provider characteristics.
A total of 52,395 eligible cases were identified: 50,926 ACDF and 1469 ACDA. Readmission was less common in the ACDA group (OR: 0.69, 95% CI: 0.48–1.0, p = 0.048). Subsequent cervical spine surgery was more common in the ACDF group in the immediate perioperative period (within 90 days of surgery) (ACDF 3.35% vs. ACDA 2.04%, OR: 0.63, 95% CI: 0.44-0.92, p = 0.015). At 1-, 3-, and 5-year postoperatively, rates of subsequent cervical surgeries were similar between the two cohorts.
We found no protective benefit for ACDA versus ACDF for single-level disease at up to 5-year follow-up in the largest cohort of patients examined to date. Early complications were rare in both cohorts stressing the value of large cohort studies to study risk factors for rare events.
KeywordsArtificial disc Cervical degenerative disc disease Reoperations Spinal fusion Total disc arthroplasty
Compliance with ethical standards
Conflicts of Interest
Michael P. Kelly has received support from the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and has received grants from AO North America (AONA) Spine, Orthopaedic Research and Education Foundation (OREF), Cervical Spine Research Society (CSRS), Barnes Jewish Foundation, and Fox Family Foundation. Nelson F. SooHoo has previously been supported by CSRS. For the remaining authors, no conflicts of interest or sources of funding were declared. The devices that are the subject of this manuscript are FDA approved for this indication. The Committee for the Protection of Human Subjects (CPHS) has reviewed and approved this project (Project Number: 12-08-0514). This approval is issued under the California Health and Human Services Agency’s Federalwide Assurance #00000681. This study received direct support from the CSRS.
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