Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2023 Oct 15;48(20):E342-E348. doi: 10.1097/BRS.0000000000004560. Epub 2022 Dec 28.
Descriptive epidemiologic study.
To compare trends in utilization and predictive factors for single-level cervical disc arthroplasty (CDA) relative to anterior cervical discectomy and fusion (ACDF) over the years.
CDA is an alternative to ACDF for the treatment of cervical spine pathologies. With both procedures performed for similar indications, controversy on best practices exists.
Patients who underwent single-level CDA or ACDF were identified in the 2010 through 2021 PearlDiver M151Ortho data set. The yearly number of CDAs performed and proportionality was assessed. Predictive patient factors for undergoing CDA as opposed to ACDF were determined. Kaplan Meyer survival analysis with an endpoint of cervical spine reoperation compared 5-year outcomes between CDA and ACDF.
From 2010 to 2021, 19,301 single-level CDAs and 181,476 single-level ACDFs were identified. The proportional utilization of CDA relative to ACDF increased from 4.00% in 2010 to 14.15% in 2018 ( P < 0.0001), after which there was a plateau between 2018 and 2021 where proportional utilization was 14.47% ( P = 0.4654). Multivariate analysis identified several predictors of undergoing CDA rather than ACDF, including: younger age [odds ratio (OR) per decade decrease: 1.72], having surgery performed in the Midwest, Northeast, or West (relative to South, OR: 1.16, 1.13, 2.26, respectively), having Commercial insurance (relative to Medicare, OR: 1.75), and having surgery performed by an orthopedic surgeon (relative to a neurological surgeon, OR: 1.54) ( P < 0.0001 for each). There was no statistically significant difference in 5-year survival to further cervical spine surgery between CDA and ACDF at 5 years (97.6% vs. 97.7%, P = 0.4249).
Although the use of CDA relative to ACDF rose from 2010 to 2018, its use has subsequently plateaued between 2018 and 2021 and remained a relatively low percentage of the single-level anterior cervical surgeries performed (14.47% in 2021). The causes for such changes in the trend are unclear.
描述性流行病学研究。
比较单节段颈椎间盘置换术（CDA）与前路颈椎间盘切除融合术（ACDF）的利用趋势和预测因素，这些趋势在这些年里有所变化。
CDA 是治疗颈椎疾病的 ACDF 的一种替代方法。由于这两种手术的适应证相似，因此存在最佳实践的争议。
在 2010 年至 2021 年期间，从 PearlDiver M151Ortho 数据集中确定了进行单节段 CDA 或 ACDF 的患者。评估了每年进行的 CDA 数量及其比例。确定了患者接受 CDA 而非 ACDF 的预测因素。Kaplan Meyer 生存分析以颈椎再手术为终点，比较了 CDA 和 ACDF 术后 5 年的结果。
2010 年至 2021 年间，共确定了 19301 例单节段 CDA 和 181476 例单节段 ACDF。CDA 相对于 ACDF 的利用比例从 2010 年的 4.00%增加到 2018 年的 14.15%（P < 0.0001），此后，2018 年至 2021 年期间，这一比例保持在 14.47%（P = 0.4654）。多变量分析确定了接受 CDA 而非 ACDF 的几个预测因素，包括：年龄每减少十年（优势比[OR]：1.72），手术在中西部、东北部或西部进行（相对于南部，OR：1.16、1.13、2.26），有商业保险（相对于医疗保险，OR：1.75），以及由骨科医生进行手术（相对于神经外科医生，OR：1.54）（每项 P < 0.0001）。CDA 和 ACDF 在术后 5 年的颈椎再手术生存率无统计学差异（5 年时为 97.6% vs. 97.7%，P = 0.4249）。
尽管 CDA 相对于 ACDF 的使用从 2010 年增加到 2018 年，但此后 2018 年至 2021 年期间，其使用已趋于平稳，且在进行的单节段前路颈椎手术中仍占相对较低的比例（2021 年为 14.47%）。这种趋势变化的原因尚不清楚。
