Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021

Manjot Singh; Mariah Balmaceno-Criss; George Anderson; Kanwar Parhar; Mohammad Daher; Jerzy Gregorczyk; Jonathan Liu; Christopher L McDonald; Bassel G Diebo; Alan H Daniels

doi:10.1016/j.spinee.2024.02.016

Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021

Spine J. 2024 Feb 24:S1529-9430(24)00081-0. doi: 10.1016/j.spinee.2024.02.016. Online ahead of print.

Authors

Affiliations

¹ Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA.
² Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA; Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA.
³ Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA.
⁴ Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA.
⁵ Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA. Electronic address: Alan_daniels@brown.edu.

PMID: 38408519
DOI: 10.1016/j.spinee.2024.02.016

Abstract

Background context: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation.

Purpose: To explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA DESIGN: Retrospective cohort study.

Patient sample: A total of 433,660 patients who underwent ACDF or CDA between 2011 and 2021 were included in this study.

Outcome measures: The following data were observed for all cases: patient demographics, complications, and revisions.

Methods: The PearlDiver database was queried to identify patients who underwent ACDF and CDA between 2011 and 2021. Epidemiological analyses were performed to examine trends in cervical procedure utilization by age group and year. After matching by age, sex, Charlson Comorbidity Index (CCI), levels of operation, and reason for surgery, the early postoperative (2-week), short-term (2-year), and long-term (5-year) complications of both cervical procedures were examined.

Results: In total, 404,195 ACDF and 29,465 CDA patients were included. ACDF utilization rose by 25.25% between 2011 and 2014 while CDA utilization rose by 654.24% between 2011-2019 followed by relative plateauing in both procedures. Mann-Kendall trend test confirmed a significant but small rise in ACDF and large rise in CDA procedures from 2011 to 2021 (p<.001). After matching, ACDF and CDA had an overall complication rate of 12.20% and 8.77%, respectively, with the most common complications being subsequent anterior revision (4.96% and 3.35%) and dysphagia (3.70% and 2.98%). The ACDF cohort, especially multilevel ACDF patients, generally had more complications and higher revision rates than the CDA cohort (p<.05).

Conclusions: While ACDF utilization has plateaued since 2014, CDA rates have risen by a staggering 654.24% over the past decade. ACDF and CDA complication and revision rates were relatively low in comparison to previously published values, with significantly lower rates in CDA. Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile.

Keywords: ACDF; Anterior cervical discectomy and fusion; CDA; CDR; Cervical disc arthroplasty; Cervical disc replacement; Complications; Epidemiology; Revisions.