Tuchman Alexander, Chen Ida, Walker Corey T, Kanim Linda E, Bae Hyun W, Skaggs David L
1Departments of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
2Departments of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
J Neurosurg Spine. 2023 Dec 15;40(3):282-290. doi: 10.3171/2023.10.SPINE23640. Print 2024 Mar 1.
Long-term meta-analysis of cervical disc arthroplasty (CDA) trials report lower rates of subsequent cervical spine surgical procedures with CDA compared with anterior cervical discectomy and fusion (ACDF). The objective of this study was to compare the rate of subsequent cervical spine surgery in single-level CDA-treated patients to that of a matched cohort of single-level ACDF-treated patients by using records from 2010 to 2021 included in a large national administrative claims database (PearlDiver).
This retrospective matched-cohort study used a large national insurance claims database; 525,510 patients who had undergone a single-level ACDF or CDA between 2010 and 2021 were identified. Patients with other same-day spine procedures, as well as those for trauma, infection, or tumor, were excluded, yielding 148,531 patients. ACDF patients were matched 2:1 to CDA patients on the basis of clinical and demographic characteristics. The primary outcome was the overall incidence of all-cause cervical reoperation after index surgery. Secondary outcomes included readmission, any adverse event within 90 days, and overall reintervention after index surgery. Multivariable logistic regression analyses were adjusted for covariates and were employed to estimate the effect of the index ACDF or CDA procedure on patient outcomes. Survival was assessed using Kaplan-Meier estimation, and differences between ACDF- and CDA-treated patients were compared using log-rank tests.
After the patients were matched, 28,795 ACDF patients to 14,504 CDA patients were included. ACDF patients had higher rates of 90-day adverse events (18.4% vs 14.6%, adjusted odds ratio [aOR] 0.77, 95% CI 0.73-0.82, p < 0.001) and readmission (11.5% vs 9.7%, aOR 0.87, 95% CI 0.81-0.93, p < 0.001). Over a mean 4.3 years of follow-up, 5.0% of ACDF patients and 5.4% of CDA patients underwent reoperation (aOR 1.09, 95% CI 1.00-1.19, p = 0.059). The rate of aggregate reintervention was higher in CDA patients than in ACDF patients (11.7% vs 10.7%, aOR 1.10, p = 0.002). The Kaplan-Meier 10-year reoperation-free survival rate was worse for CDA than ACDF (91.0% vs 92.0%, p = 0.05), as was the rate of reintervention-free survival (81.2% vs 82.0%, p = 0.003).
Single-level CDA was associated with a similar rate of reoperation and higher rate of subsequent injections when compared with a matched cohort that underwent single-level ACDF. CDA was associated with lower rates of 90-day adverse events and readmissions.
颈椎间盘置换术（CDA）试验的长期荟萃分析报告称，与颈椎前路椎间盘切除融合术（ACDF）相比，CDA术后颈椎再次手术的发生率较低。本研究的目的是通过使用来自大型国家行政索赔数据库（PearlDiver）中2010年至2021年的记录，比较单节段CDA治疗患者与匹配的单节段ACDF治疗患者队列的颈椎再次手术率。
这项回顾性匹配队列研究使用了一个大型国家保险索赔数据库；确定了2010年至2021年间接受单节段ACDF或CDA的525,510名患者。排除了同一天进行其他脊柱手术的患者，以及因创伤、感染或肿瘤接受手术的患者，最终纳入148,531名患者。根据临床和人口统计学特征，将ACDF患者与CDA患者按2:1进行匹配。主要结局是初次手术后全因颈椎再次手术的总体发生率。次要结局包括再入院、90天内的任何不良事件以及初次手术后的总体再次干预。多变量逻辑回归分析对协变量进行了调整，并用于估计初次ACDF或CDA手术对患者结局的影响。使用Kaplan-Meier估计法评估生存率，并使用对数秩检验比较ACDF治疗患者和CDA治疗患者之间的差异。
患者匹配后，纳入28,795名ACDF患者和14,504名CDA患者。ACDF患者90天不良事件发生率较高（18.4%对14.6%，调整优势比[aOR]0.77，95%置信区间0.73-0.82，p<0.001）和再入院率较高（11.5%对9.7%，aOR 0.87，95%置信区间0.81-0.93，p<0.001）。在平均4.3年的随访中，5.0%的ACDF患者和5.4%的CDA患者接受了再次手术（aOR 1.09，95%置信区间1.00-1.19，p = 0.059）。CDA患者的总体再次干预率高于ACDF患者（11.7%对10.7%，aOR 1.10，p = 0.002）。CDA的Kaplan-Meier 10年无再次手术生存率比ACDF差（91.0%对92.0%，p = 0.05），无再次干预生存率也是如此（81.2%对82.0%，p = 0.003）。
与接受单节段ACDF的匹配队列相比，单节段CDA的再次手术率相似，但后续注射率较高。CDA与90天不良事件和再入院率较低相关。
