Spine · 2025
Reoperation Risks Between Cervical Disc Arthroplasty and Anterior Cervical Discectomy With Fusion: It is Not Always About Adjacent Segment Disease.
СтатьяНазвание и аннотация: Перевод в очереди
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Alsalek Samir, Chang Richard N, Harary Maya, Florence Timothy, Laiwalla Azim N, Prentice Heather A, Brara Harsimran S, Harris Jessica E, Hirt Daniel, Richards Hunter G, Guppy Kern H, Rahman Shayan U
Аннотация
STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: To determine risks of reoperations for adjacent segment disease (ASD) and all-cause reoperations following cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF).
SUMMARY OF BACKGROUND DATA: To reduce the risk of ASD, CDA was developed to preserve mobility. While studies show CDA lowers ASD reoperation rates, few have included all-cause reoperation risks.
METHODS: Using data from a National Spine Registry, patients (18-60 yr old) with cervical degenerative disc disease who underwent a primary one-level and two-level CDA or ACDF were selected. Patients with ACDF were 3:1 propensity-score matched to CDA patients. Cox Proportional-Hazards regression was used to evaluate reoperations for ASD and all-cause risks. Hazard ratios (HR) and 95% CIs were presented; P < 0.05 was the significance threshold.
RESULTS: The cohort consisted of 6318 patients with a mean follow-up of 6.9 years. Propensity score matching yielded 809 CDA patients and 2427 ACDF patients. In Cox Regression analysis, a lower risk of reoperation for ASD was observed for 1-level CDA compared with ACDF (HR=0.86, 95% CI=0.64-1.15, P = 0.31) but without statically significance. For one-level and two-level, no difference in all-cause reoperation risks was found (HR=0.84, 95% CI=0.64-1.12, P = 0.25) and (HR=0.67, 95% CI=0.33-1.37, P = 0.27), respectively. Mean time to ASD reoperation was 3.9 years (SD=3.5) for CDA and 4.4 years (SD=3.1) for ACDF.
CONCLUSION: With nearly seven years of average follow-up, this large registry-based study showed that one-level CDA did not significantly reduce the risk of ASD or all-cause reoperations compared with ACDF. Similar results were only seen for all-cause reoperations in two-level CDA. Importantly, ASD reoperations occurred within four to five years on average, underscoring that while CDA preserves motion, the risk of subsequent surgery remains. These findings highlight the real-world performance of CDA and may reflect other factors that increase all-cause reoperations, which may have been underreported.
OBJECTIVE: To determine risks of reoperations for adjacent segment disease (ASD) and all-cause reoperations following cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF).
SUMMARY OF BACKGROUND DATA: To reduce the risk of ASD, CDA was developed to preserve mobility. While studies show CDA lowers ASD reoperation rates, few have included all-cause reoperation risks.
METHODS: Using data from a National Spine Registry, patients (18-60 yr old) with cervical degenerative disc disease who underwent a primary one-level and two-level CDA or ACDF were selected. Patients with ACDF were 3:1 propensity-score matched to CDA patients. Cox Proportional-Hazards regression was used to evaluate reoperations for ASD and all-cause risks. Hazard ratios (HR) and 95% CIs were presented; P < 0.05 was the significance threshold.
RESULTS: The cohort consisted of 6318 patients with a mean follow-up of 6.9 years. Propensity score matching yielded 809 CDA patients and 2427 ACDF patients. In Cox Regression analysis, a lower risk of reoperation for ASD was observed for 1-level CDA compared with ACDF (HR=0.86, 95% CI=0.64-1.15, P = 0.31) but without statically significance. For one-level and two-level, no difference in all-cause reoperation risks was found (HR=0.84, 95% CI=0.64-1.12, P = 0.25) and (HR=0.67, 95% CI=0.33-1.37, P = 0.27), respectively. Mean time to ASD reoperation was 3.9 years (SD=3.5) for CDA and 4.4 years (SD=3.1) for ACDF.
CONCLUSION: With nearly seven years of average follow-up, this large registry-based study showed that one-level CDA did not significantly reduce the risk of ASD or all-cause reoperations compared with ACDF. Similar results were only seen for all-cause reoperations in two-level CDA. Importantly, ASD reoperations occurred within four to five years on average, underscoring that while CDA preserves motion, the risk of subsequent surgery remains. These findings highlight the real-world performance of CDA and may reflect other factors that increase all-cause reoperations, which may have been underreported.