Spine surgery and related research · 2026
Long-Term Risk of Reoperation after Hybrid Cervical Surgery with One-Level Anterior Cervical Corpectomy and Fusion versus Multilevel Anterior Cervical Discectomy and Fusion: A Retrospective Cohort Study.
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N Baumann Anthony, J Trager Robert, S Anaspure Omkar, T Conry Keegan, Preston Gordon, C Hoffmann Jacob
Аннотация
STUDY DESIGN: Retrospective cohort study.
INTRODUCTION: HCS involving one-level anterior cervical corpectomy and fusion (1L-ACCF) along with ACDF is an alternative technique to the standard of mACDF for DCM, with limited evidence available on postoperative outcomes. The primary objective is to compare 4-year reoperation risk after hybrid cervical surgery (HCS) versus multilevel anterior cervical discectomy and fusion (mACDF) in degenerative cervical myelopathy (DCM). Secondarily, the study evaluates the association of surgical technique with pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia.
METHODS: Using TriNetX, we identified adults (≥18 years) with DCM who underwent either HCS with 1L-ACCF or ≥4-level mACDF from 2004 to 2020. Patients were grouped by surgery type, and reoperation risk factors were used for propensity matching. The primary outcome was the risk ratio ([RR], 95% confidence interval [CI]) for reoperation; secondary outcomes included RRs for pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia, as well as the mean number of oral opioid prescriptions.
RESULTS: There were 1,203 patients with DCM per cohort (mean age=56 years) after matching. Within the HCS with 1L-ACCF cohort, compared to the mACDF cohort, there was a statistically significant greater risk of reoperation (10.2% vs 7.6%; RR=1.34 [1.03-1.73]; p=0.0267), yet a significantly lower risk of pseudoarthrosis (22.6% vs 32.3%; RR=0.70 [0.61-0.80]; p<0.001) and dysphagia (12.1% vs 18.8%; RR=0.65 [0.53-0.78]; p<0.001). There was no statistically significant difference in the risk or mean count of oral opioid prescriptions between cohorts (RR=0.96 [0.91-1.01]; 8.4 vs 8.9; p=0.471).
CONCLUSIONS: There appears to be a higher risk of reoperation after HCS with 1L-ACCF compared to that with mACDF in adult patients with DCM. However, HCS with 1L-ACCF was associated with a lower risk of pseudoarthrosis and dysphagia as compared to that of mACDF, with no difference in oral opioid prescriptions. Surgeons can consider these tradeoffs in the complex decision-making process when recommending a surgical approach for DCM.
INTRODUCTION: HCS involving one-level anterior cervical corpectomy and fusion (1L-ACCF) along with ACDF is an alternative technique to the standard of mACDF for DCM, with limited evidence available on postoperative outcomes. The primary objective is to compare 4-year reoperation risk after hybrid cervical surgery (HCS) versus multilevel anterior cervical discectomy and fusion (mACDF) in degenerative cervical myelopathy (DCM). Secondarily, the study evaluates the association of surgical technique with pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia.
METHODS: Using TriNetX, we identified adults (≥18 years) with DCM who underwent either HCS with 1L-ACCF or ≥4-level mACDF from 2004 to 2020. Patients were grouped by surgery type, and reoperation risk factors were used for propensity matching. The primary outcome was the risk ratio ([RR], 95% confidence interval [CI]) for reoperation; secondary outcomes included RRs for pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia, as well as the mean number of oral opioid prescriptions.
RESULTS: There were 1,203 patients with DCM per cohort (mean age=56 years) after matching. Within the HCS with 1L-ACCF cohort, compared to the mACDF cohort, there was a statistically significant greater risk of reoperation (10.2% vs 7.6%; RR=1.34 [1.03-1.73]; p=0.0267), yet a significantly lower risk of pseudoarthrosis (22.6% vs 32.3%; RR=0.70 [0.61-0.80]; p<0.001) and dysphagia (12.1% vs 18.8%; RR=0.65 [0.53-0.78]; p<0.001). There was no statistically significant difference in the risk or mean count of oral opioid prescriptions between cohorts (RR=0.96 [0.91-1.01]; 8.4 vs 8.9; p=0.471).
CONCLUSIONS: There appears to be a higher risk of reoperation after HCS with 1L-ACCF compared to that with mACDF in adult patients with DCM. However, HCS with 1L-ACCF was associated with a lower risk of pseudoarthrosis and dysphagia as compared to that of mACDF, with no difference in oral opioid prescriptions. Surgeons can consider these tradeoffs in the complex decision-making process when recommending a surgical approach for DCM.