Turkish Neurosurgery
Revision Anterior Cervical Discectomy and Fusion and Revision Cervical Arthroplasty Are Associated with Similar Outcomes: Real-World Analysis from a National Quality Registry
Sung Huang Laurent Tsai1, Mohammed Ali Alvi3, Saema Tazyeen4, Yagiz Yolcu3, Saad Javeed3, Arjun Sebastian5, Brett Freedman5, Mohamad Bydon3, Benajmin Elder3
1Chang Gung Memorial Hospital, Keelung branch, Department of Orthopedic Surgery, Taoyuan,
2Johns Hopkins Bloomberg School of Public Health, School of Public Health, Baltimore,
3Mayo Clinic, Department of Neurologic Surgery, Rochester,
4Dubai Medical Univeristy, Medical School, Dubai,
5Mayo Clinic, Department of Orthopedic Surgery, Rochester,
DOI: 10.5137/1019-5149.JTN.33270-20.4

Aim:Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly employed cervical spine procedures for degenerative cervical spine pathology. However, patients may require a revision procedure, most commonly due to recurrence of same-level pathology, adjacent segment disease or hardware related complications. In the current study, we sought to utilize a national surgical quality registry to compare 30-day quality outcomes between repeat ACDF and CDAMaterial and Methods:The National Surgical Quality Improvement Project (NSQIP) Participant User Files (PUF) for the years 2005- 2018 was queried for patients undergoing repeat ACDF and CDA using current procedural terminology (CPT) and international classification of disease (ICD)-9th version codes. We compared demographic and baseline clinical characteristics, operative characteristics and 30-day readmissions, reoperations, and complications between the two groups. We also performed multivariable analyses to assess the impact of repeat procedure type on outcomes of interest.Results:A total of 3,957 patients were identified, of which 182 patients underwent a revision/removal of arthroplasty while 3,775 patients underwent revision or removal of fusion. Up to 4.6% patients (n=179) in the repeat ACDF group had a complication, compared to 0.5% (n=1) in the CDA group. The 30-day readmission rate was found to be similar between the two groups (repeat-ACDF: 3.8% (n=145), vs repeat-CDA: 2.2% (n=4); p=0.23). Similarly, the 30-day reoperation rate was also not found to be different between the two groups (repeat-ACDF: 3.9% (n=149) vs repeat-CDA: 2.7% (n=5);p=0.39). On multivariable analysis, removal or revision ACDF was only found to be significantly associated with an increased risk of 30-day complications (OR: 8.00, 95% CI: 1.07-59.79, p=0.04).Conclusion:Repeat ACDF or repeat CDA can be performed safely and are associated with optimal 30-day outcomes, comparable to those for index procedures. However, patients undergoing revision ACDF, compared to those undergoing revision CDA may be slightly more likely to have a complication.

Corresponding author : Benajmin Elder