A real-world analysis of hybrid CDA and ACDF compared to multilevel ACDF

Abstract

Background Multilevel anterior cervical discectomy and fusion (mACDF) is the gold standard for multilevel spinal disease; although safe and effective, mACDF can limit regular spinal motion and contribute to adjacent segment disease (ASD). Hybrid surgery, composed of ACDF and cervical disc arthroplasty, has the potential to reduce ASD by retaining spinal mobility. This study examined the safety of hybrid surgery by utilizing administrative claims data to compare real-world rates of subsequent surgery and post-procedural hospitalization within populations of patients undergoing hybrid surgery versus mACDF for multilevel spinal disease. Methods This observational, retrospective analysis used the MarketScan Commercial and Medicare Database from July 2013 through June 2020. Propensity score matched cohorts of patients who received hybrid surgery or mACDF were established based on the presence of spinal surgery procedure codes in the claims data and followed over a variable post-period. Rates of subsequent surgery and post-procedural hospitalization (30- and 90-day) were compared between hybrid surgery and mACDF cohorts. Results A total of 430 hybrid surgery patients and 2,136 mACDF patients qualified for the study; average follow-up was approximately 2 years. Similar rates of subsequent surgery (Hybrid: 1.9 surgeries/100 patient-years; mACDF: 1.8 surgeries/100 patient-years) were observed for the two cohorts. Hospitalization rates were also similar across cohorts at 30 days post-procedure (Hybrid: 0.67% hospitalized/patient-year; mACDF: 0.87% hospitalized/patient-year). At 90 days post-procedure, hybrid surgery patients had slightly lower rates of hospitalization compared to mACDF patients (0.23% versus 0.42% hospitalized/patient-year; p < 0.05). Conclusions Findings of this real-world, retrospective cohort study confirm prior reports indicating that hybrid surgery is a safe and effective intervention for multilevel spinal disease which demonstrates non-inferiority in relation to the current gold standard mACDF. The use of administrative claims data in this analysis provides a unique perspective allowing the inclusion of a larger, more generalizable population has historically been reported on in small cohort studies.

Current Evidence for Hybrid Constructs

“…Already, several biomechanical and clinical studies have demonstrated promising outcomes and suggest non-inferiority of HS compared with 2-level and 3-level ACDF. 23,[52][53][54] However, current literature is often limited by small sample size and relatively short follow-up. Future work may continue to expand on the impact of both location and number of ACDF and CDA, particularly for ≥ 3-level HS.…”

“…According to a recent retrospective analysis on the MarketScan Commercial database, Kim et al 23 reported on 558 HS between 2013 and 2020. They found that 2-level primary HS (60.9%) were the most common, followed by 3+-level primary (30.5%), and secondary HS (8.6%).…”

“…There has been growing interest in the potential for HS to address patient-specific cervical spine pathology. Already, several biomechanical and clinical studies have demonstrated promising outcomes and suggest non-inferiority of HS compared with 2-level and 3-level ACDF 23,52–54 . However, current literature is often limited by small sample size and relatively short follow-up.…”

The Kinematics and Biomechanics for Non-Contiguous Anterior Cervical Discectomy and Fusion, Cervical Disc Arthroplasty, and Hybrid Cervical Surgery: A Systematic Review

“…Cervical disc degenerative disease (CDDD) is a common spinal pathology that impacts many patients worldwide and has received extensive attention in the literature [1][2][3][4][5]. Estimates of the prevalence of CDDD in the literature range from 37% to 96%, depending on patient age [6].…”

“…Estimates of the prevalence of CDDD in the literature range from 37% to 96%, depending on patient age [6]. Numerous cervical surgical procedures exist for the treatment of CDDD, including anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and a combination of both of those procedures called hybrid cervical surgery (HCS) [1][2][3][4][5][7][8][9][10][11][12][13]. Patients can develop CDDD in a multi-level contiguous manner, in which adjacent levels of the cervical spine are affected, or in a non-contiguous manner, in which there is "skip-level" CDDD or level(s) of diseased cervical segments between level(s) of healthy cervical segments [1,[3][4][5]14,15].…”