Spine · 2026
Cervical Disc Arthroplasty Has Higher Rates of Revision, But Lower Rates of Adjacent Segment Disease, Compared to ACDF.
СтатьяНазвание и аннотация: Перевод в очереди
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Friedman Lindley I N, Truumees Heili, Gonzalez Fernando, Geerling Danielle M, Spina Nicholas T, Spiker William Ryan, Brodke Darrel S, Lawrence Brandon D, Karamian Brian A
Аннотация
STUDY DESIGN: Retrospective cohort.
OBJECTIVE: To evaluate differences, if any, in patient selection, patient-reported outcomes, and complication profiles between anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA).
SUMMARY OF BACKGROUND DATA: ACDF has long been the standard for cervical degenerative disc disease (DDD), but concerns about adjacent segment disease (ASD) have driven interest in CDA as a motion-preserving alternative. We hypothesize that there will be differences in patient demographics, but not outcomes, for those undergoing ACDF and CDA for cervical DDD.
METHODS: A retrospective review was conducted of patients undergoing single-level ACDF or CDA at a single academic institution between 2014 and 2024. Demographics, surgical characteristics, patient-reported outcomes, and complications were extracted from electronic medical records. Primary outcomes included postoperative hematoma, 30-day readmissions, ASD noted by radiology reads or in orthopedic spine clinic notes, and reoperations.
RESULTS: Data from 337 patients (207 ACDF, 130 CDA) was analyzed. Compared to ACDF patients, CDA patients were younger (44.44 vs. 54.43 y, P<0.001), had lower osteoporosis rates (1.54% vs. 11.11%, P<0.001), and were most frequently ASA Class II (67.69% vs. 50.24%, P<0.001). Patient-reported outcomes generally did not differ across procedure types. Revision at the index level was more common in CDA (5.38% vs. 0.48%, P=0.006), whereas extension to an adjacent level was more common in ACDF (9.66% vs. 2.31%, P=0.008). Regression analyses controlling for age, BMI, osteoporosis, and surgical levels confirmed CDA as a unique predictor of increased revision risk (OR 12.48, P=0.042), and ACDF as a unique predictor of increased ASD risk (OR 0.11, P<0.001).
CONCLUSIONS: ACDF and CDA are safe and effective for single-level cervical DDD. CDA was associated with lower readmissions and reduced adjacent pathology, but higher index-level revision risk. These findings support CDA as a motion-preserving alternative to ACDF in appropriately selected patients.
LEVEL OF EVIDENCE: III.
OBJECTIVE: To evaluate differences, if any, in patient selection, patient-reported outcomes, and complication profiles between anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA).
SUMMARY OF BACKGROUND DATA: ACDF has long been the standard for cervical degenerative disc disease (DDD), but concerns about adjacent segment disease (ASD) have driven interest in CDA as a motion-preserving alternative. We hypothesize that there will be differences in patient demographics, but not outcomes, for those undergoing ACDF and CDA for cervical DDD.
METHODS: A retrospective review was conducted of patients undergoing single-level ACDF or CDA at a single academic institution between 2014 and 2024. Demographics, surgical characteristics, patient-reported outcomes, and complications were extracted from electronic medical records. Primary outcomes included postoperative hematoma, 30-day readmissions, ASD noted by radiology reads or in orthopedic spine clinic notes, and reoperations.
RESULTS: Data from 337 patients (207 ACDF, 130 CDA) was analyzed. Compared to ACDF patients, CDA patients were younger (44.44 vs. 54.43 y, P<0.001), had lower osteoporosis rates (1.54% vs. 11.11%, P<0.001), and were most frequently ASA Class II (67.69% vs. 50.24%, P<0.001). Patient-reported outcomes generally did not differ across procedure types. Revision at the index level was more common in CDA (5.38% vs. 0.48%, P=0.006), whereas extension to an adjacent level was more common in ACDF (9.66% vs. 2.31%, P=0.008). Regression analyses controlling for age, BMI, osteoporosis, and surgical levels confirmed CDA as a unique predictor of increased revision risk (OR 12.48, P=0.042), and ACDF as a unique predictor of increased ASD risk (OR 0.11, P<0.001).
CONCLUSIONS: ACDF and CDA are safe and effective for single-level cervical DDD. CDA was associated with lower readmissions and reduced adjacent pathology, but higher index-level revision risk. These findings support CDA as a motion-preserving alternative to ACDF in appropriately selected patients.
LEVEL OF EVIDENCE: III.