Reoperation and Perioperative Complications after Surgical Treatment of Cervical Radiculopathy: A Comparison between Three Procedures

Abstract

Study Design. A retrospective database study.Objective. The purpose of our study was to compare the perioperative complications and reoperation rates after anterior cervical discectomy and fusion (ACDF), cervical disk arthroplasty (CDA), and posterior cervical foraminotomy (PCF) in patients treated for cervical radiculopathy. Summary of Background Data. Cervical radiculopathy results from compression or irritation of nerve roots in the cervical spine. While most cervical radiculopathy is treated nonoperatively, ACDF, CDA, and PCF are the techniques most commonly used if operative intervention is indicated. There is limited research evaluating the perioperative complications of these surgical techniques. Materials and Methods. A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of cervical radiculopathy that underwent ACDF, CDA, or PCF at one or two levels from 2007 to 2016. Perioperative complications and reoperations following each of the procedures were assessed. Results. During the study period, 25,051 patients underwent ACDF, 522 underwent CDA, and 3986 underwent PCF. After propensity score matching, each of the three groups consisted of 507 patients. Surgical site infection rates were highest after PCF (2.17%) compared with ACDF (0.20%) and CDA (0.59%) at 30 days and three months (P = 0.003, P < 0.001), respectively. New-onset cervicalgia was highest following ACDF (34.32%) and lowest after PCF (22.88%) at three and six months (P < 0.001 and P = 0.003), respectively. Revision surgeries were highest among those who underwent CDA (6.90%) versus ACDF (3.16%) and PCF (3.55%) at six months (P = 0.007). Limb paralysis was significantly higher after PCF compared with CDA and ACDF at six months (P < 0.017). Conclusions. The rate of surgical site infection was higher in PCF compared with ACDF and CDA. New-onset cervicalgia was higher after ACDF compared with PCF and CDA at short-term follow-up. Revision surgeries were highest among those undergoing CDA and lowest in those undergoing ACDF.

Spine

“…It was therefore refreshing to see the publication of the current retrospective study from Washington (USA) , which compared the revision rates and complications seen in these three procedures. 7 The surgeons used the PearlDiver Patient Record Database to identify cases of cervical radiculopathy that underwent ACDF, cervical disc arthroplasty (CDA), or PCF at one or two levels from 2007 to 2016. The outcomes assessed were coded complications, which includes the majority of outcomes of interest, but no actual functional or pain scores.…”

Impact of Posterior Cervical Foraminotomy Before or After Cervical Disk Replacement

“…28 Estimated rate of revision surgery after CDR ranges from 1% to 15% dependent on the study and follow-up time. 23,[29][30][31] Skovrlj et al 30 reports that from a total of 1068 cervical arthroplasty levels operated on with a mean follow-up of 2.3 years (range, 2-4 y), the established mean rate of reoperation (laminoforaminotomy, laminectomy, and/or posterior fusion ) is 1.0% (range, 0%-3.1%), revision (adjusting or modifying original implant) at 0.2% (range, 0%-0.5%), and removal (often followed by ACDF) at 1.2% (range, 0%-1.9%). In a multicenter analysis by Lee et al, 32 3350 primary CDR procedures between 2008 and 2017 were studied with an arthroplasty removal rate of 2.1%.…”

“…In a recent retrospective review that included 507-patient propensity matched cohorts, one for ACDF, PCF, and CDR, the rate of revision surgeries was significantly higher among CDR patients than ACDF or PCF (6.9% vs. 3.16% vs. 3.55%, respectively). 31 CDR can present implant-related complications. Quan et al 34 reported a case of posterior migration of the implant, whereas Hrabálek et al 35 reported no implantrelated complications, such as migration, loosening, or subsidence; however, the Hrabaĺek et al 35 study was limited by its small sample size.…”

“…CDR utilization (an increase of 413% from 2010 to 2020) and revision (an increase of 141% from 2010 to 2020) have shown a high rate of annual growth in the United States, while CDR revision rates demonstrate a declining trend and compare favorably with ACDF 28 . Estimated rate of revision surgery after CDR ranges from 1% to 15% dependent on the study and follow-up time 23,29–31 . Skovrlj et al 30 reports that from a total of 1068 cervical arthroplasty levels operated on with a mean follow-up of 2.3 years (range, 2–4 y), the established mean rate of reoperation (laminoforaminotomy, laminectomy, and/or posterior fusion ) is 1.0% (range, 0%–3.1%), revision (adjusting or modifying original implant) at 0.2% (range, 0%–0.5%), and removal (often followed by ACDF) at 1.2% (range, 0%–1.9%).…”

“…This included 21 patients who underwent a secondary procedure for ASD, though the secondary procedures were not specified. In a recent retrospective review that included 507-patient propensity matched cohorts, one for ACDF, PCF, and CDR, the rate of revision surgeries was significantly higher among CDR patients than ACDF or PCF (6.9% vs. 3.16% vs. 3.55%, respectively) 31 …”