Single-level Anterior Cervical discEctomy and Fusion has Lower Five-year Revisions than Posterior Cervical Foraminotomy in a Large National Cohort

Abstract

Study Design. A retrospective cohort study using the 2010-2020 MSpine PearlDiver administrative data set. Objective. To compare perioperative adverse events and fiveyear revisions for single-level anterior cervical discectomy and fusion (ACDF) versus posterior cervical foraminotomy (PCF). Summary of Background Data. Cervical disk disease can often be treated surgically using single-level ACDF or PCF. Prior studies have suggested that posterior approaches provide similar shortterm outcomes as ACDF; however, posterior procedures may have an increased risk of revision surgery. Materials and Methods. The database was queried for patients undergoing elective single-level ACDF or PCF (excluding cases performed for myelopathy, trauma, neoplasm, and/or infection). Outcomes, including specific complications, readmission, and reoperations, were assessed. Multivariable logistic regression was used to ascertain odds ratios (OR) of 90-day adverse events controlling for age, sex, and comorbidities. Kaplan-Meier survival analysis was performed to determine five-year rates of cervical reoperation in the ACDF and PCF cohorts. Results. A total of 31,953 patients treated by ACDF (29,958, 93.76%) or PCF (1995, 6.24%) were identified. Multivariable analysis, controlling for age, sex, and comorbidities, demonstrated that PCF was associated with significantly greater odds of aggregated serious adverse events (OR 2.17, P < 0.001), wound dehiscence (OR 5.89, P < 0.001), surgical site infection (OR 3.66, P < 0.001), and pulmonary embolism (OR 1.72, P = 0.04).However, PCF was associated with significantly lower odds of readmission (OR 0.32, P < 0.001), dysphagia (OR 0.44, P < 0.001), and pneumonia (OR 0.50, P = 0.004). At five years, PCF cases had a significantly higher cumulative revision rate compared with ACDF cases (19.0% vs. 14.8%, P < 0.001). Conclusions. The current study is the largest to date to compare short-term adverse events and five-year revision rates between single-level ACDF and PCF for nonmyelopathy elective cases. Perioperative adverse events differed by procedure, and it was notable that the incidence of cumulative revisions was higher for PCF. These findings can be used in decision-making when there is clinical equipoise between ACDF and PCF.

Anterior cervical decompression and fusion at one and two levels: trends and factors associated with structural allograft versus synthetic cages

“…The current study utilized the 2010 through October 2021 PearlDiver M157Ortho administrative database (PearlDiver Technologies, Colorado Springs). This is a commercially used administrative US database containing 157 million patients [17] , [18] , [19] , [20] , [21] . As data from the database is output in deidentified, aggregated, and Health Insurance Portability and Accountability Act compliant fashion, our Institutional Review Board deemed studies using this database as exempt from review.…”

Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications

“…This retrospective study used the 2015 to 2021 October PearlDiver M157 administrative database (Colorado Springs, CO), which is a large database that contains records from approximately 157 million orthopaedic patients and is well established for use in orthopaedic studies. [11][12][13][14] As the data are output in deidentified and aggregated nature, our Institutional Review Board deemed studies using this data set exempt from review.…”

Biomechanical evaluation of the novel assembled internal fixed system in C2–C3 anterior cervical discectomy and fusion: a finite element analysis

“…Anterior cervical discectomy and fusion (ACDF) is a widely employed surgical technique known for its high efficacy in addressing degenerative disc disease or cervical disc herniation within the cervical spine [ 1 ]. It provides direct access to remove the herniated or degenerated disc, relieving pressure on the nerves, and restoring normal functioning and symptom resolution.…”