• Adam M Gordon, Faisal R Elali, and Ahmed Saleh.
• Questrom School of Business, Boston University, Boston, MA.
• Spine. 2024 Jun 25.

Study DesignRetrospective Case-Control study.ObjectivesThis study aimed to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF).Summary Of Background DataProspective studies have compared patient reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported.Patients And MethodsA nationwide database was queried for patients undergoing primary single level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum of 5-year follow-up. Patients undergoing CDA were 1:5 ratio matched to patients undergoing ACDF by age, sex, comorbidities, and overall Elixhauser comorbidity index (ECI). Objectives were to compare the rates and risk factors of all-cause 5-year revisions for those undergoing single level CDA versus ACDF. Multivariate logistic regression models computed odds ratios (OR) of revisions within 5 years. P values less than 0.001 were significant.ResultsA total of 32,953 patients underwent single level CDA (N=5,640) or ACDF (N=27,313) with 5-Year minimum follow-up. The incidence of all cause revisions within 5 years were 1.24% for CDA and 9.23% for ACDF (P<0.001). After adjustment, patients undergoing single level ACDF had significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P<0.0001). Additional patient specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P<0.0001), depression (OR: 1.23; P<0.0001), cardiac arrythmias (OR: 1.21; P=0.0008), hypertension (OR: 1.20; P=0.0006), and tobacco use (OR: 1.18; P=0.0003).ConclusionsIn this study of nearly 33,000 single level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients regarding 5-year revisions following single level CDA or ACDF.Level Of EvidenceIII.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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