Outcomes Following Two-Level Cervical Disc Arthroplasty Relative to Two-Level Anterior Cervical Discectomy.

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To evaluate postoperative adverse events, readmissions, and 5-year survival to reoperation for 2-level cervical disc arthroplasty (CDA) relative to 2-level anterior cervical discectomy and fusion (ACDF).

BACKGROUND

CDA and ACDF are both treatment options for degenerative cervical spine pathology. Relative to ACDF, CDA is a relatively novel treatment option, and limited research exists comparing outcomes between 2-level CDA and 2-level ACDF.

PATIENTS AND METHODS

Patients undergoing 2-level CDA or 2-level ACDF were isolated from the PearlDiver M165Ortho database. These 2 cohorts were matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The odds of 90-day postoperative adverse events were compared between the two groups by multivariable analysis. Overall cost-of-care for the first 90 days postoperatively and 5-year survival to cervical spine reoperation were then assessed.

RESULTS

Of the 2-level cases identified, only 3.9% had CDA, and the rest had ACDF. After matching, there were 4224 patients in each of the study groups. With controlling for patient age, sex, and Elixhauser Comorbidity Index on multivariable analysis, patients undergoing 2-level CDA had significantly lower odds of experiencing 90-day dysphagia [odds ratio (OR): 0.60, P < 0.0001 driving aggregated any adverse event (OR: 0.65, P < 0.0001)] and readmission (OR: 0.69, P = 0.0002). The median 90-day cost of care was greater for patients undergoing 2-level ACDF ($4776.00 vs . $3191.00, P < 0.0001). No significant difference in 5-year survival to cervical spine reoperation was identified ( P = 0.7).

CONCLUSIONS

Relative to patients undergoing 2-level ACDF, patients undergoing 2-level CDA were found to have significantly lower odds of 90-day readmissions and minor adverse events (dysphagia), while rates of major adverse events (pulmonary embolism, deep vein thrombosis, sepsis, etc .) were comparable between the groups. Further, patients undergoing CDA had lower cost of overall care, but no difference in 5-year survival to cervical spine reoperation. Thus, it may be appropriate to further consider CDA when 2-level surgery is pursued.