Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA.
Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA; Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA.
Spine J. 2024 Aug;24(8):1342-1351. doi: 10.1016/j.spinee.2024.02.016. Epub 2024 Feb 24.
Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation.
To explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA.
Retrospective cohort study.
A total of 433,660 patients who underwent ACDF or CDA between 2011 and 2021 were included in this study.
The following data were observed for all cases: patient demographics, complications, and revisions.
The PearlDiver database was queried to identify patients who underwent ACDF and CDA between 2011 and 2021. Epidemiological analyses were performed to examine trends in cervical procedure utilization by age group and year. After matching by age, sex, Charlson Comorbidity Index (CCI), levels of operation, and reason for surgery, the early postoperative (2-week), short-term (2-year), and long-term (5-year) complications of both cervical procedures were examined.
In total, 404,195 ACDF and 29,465 CDA patients were included. ACDF utilization rose by 25.25% between 2011 and 2014 while CDA utilization rose by 654.24% between 2011-2019 followed by relative plateauing in both procedures. Mann-Kendall trend test confirmed a significant but small rise in ACDF and large rise in CDA procedures from 2011 to 2021 (p<.001). After matching, ACDF and CDA had an overall complication rate of 12.20% and 8.77%, respectively, with the most common complications being subsequent anterior revision (4.96% and 3.35%) and dysphagia (3.70% and 2.98%). The ACDF cohort, especially multilevel ACDF patients, generally had more complications and higher revision rates than the CDA cohort (p<.05).
While ACDF utilization has plateaued since 2014, CDA rates have risen by a staggering 654.24% over the past decade. ACDF and CDA complication and revision rates were relatively low in comparison to previously published values, with significantly lower rates in CDA. Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile.
颈椎前路椎间盘切除融合术（ACDF）和颈椎间盘置换术（CDA）是常用于治疗颈椎神经根病和颈椎病的手术。因此，有必要对这两种手术的利用趋势和翻修手术率进行调查。
探讨 ACDF 和 CDA 的流行病学、术后并发症和再手术率。
回顾性队列研究。
共纳入 2011 年至 2021 年间接受 ACDF 或 CDA 的 433660 例患者。
所有病例的患者人口统计学数据、并发症和翻修情况。
使用 PearlDiver 数据库检索 2011 年至 2021 年间接受 ACDF 和 CDA 的患者。通过年龄组和年份对颈椎手术利用情况进行流行病学分析，以考察趋势。在年龄、性别、Charlson 合并症指数（CCI）、手术水平和手术原因匹配后，对两种颈椎手术的早期（2 周）、短期（2 年）和长期（5 年）并发症进行了检查。
共纳入 404195 例 ACDF 和 29465 例 CDA 患者。2011 年至 2014 年期间，ACDF 的利用率上升了 25.25%，而 2011 年至 2019 年期间，CDA 的利用率上升了 654.24%，此后两种手术的利用率均相对稳定。Mann-Kendall 趋势检验证实，2011 年至 2021 年期间，ACDF 和 CDA 手术的数量均有显著但较小的上升（p<.001）。匹配后，ACDF 和 CDA 的总体并发症发生率分别为 12.20%和 8.77%，最常见的并发症为随后的前路翻修（4.96%和 3.35%）和吞咽困难（3.70%和 2.98%）。与 CDA 组相比，ACDF 组（尤其是多节段 ACDF 患者）的并发症和翻修率通常更高（p<.05）。
尽管自 2014 年以来 ACDF 的利用率已经趋于平稳，但过去十年间 CDA 的使用率却惊人地上升了 654.24%。与之前发表的数据相比，ACDF 和 CDA 的并发症和翻修率相对较低，且 CDA 的并发症和翻修率明显更低。尽管本研究由于缺乏颈椎放射学数据，因此无法为患有颈椎神经根病或颈椎病的患者推荐这两种手术，但 CDA 可能与并发症和翻修情况的轻微改善相关。
