Pavan S Upadhyayula1, John K Yue2, Erik I Curtis3, Reid Hoshide3, Joseph D Ciacci4. 1. Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, United States; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States. 2. Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, United States; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States. 3. Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, United States. 4. Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, United States. Electronic address: jciacci@ucsd.edu.
Abstract
OBJECTIVE: Cervical disc arthroplasty (CDA) is a recent alternative to anterior cervical discectomy and fusion (ACDF) in patients suffering cervical disc herniation and degeneration. To date, a systematic analysis of their comparative advantages and risks following elective surgery remains elusive. METHODS: Adult patients undergoing elective CDA or ACDF were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2011-2014. A total of 19,369 patients were matched 1:1 by age, sex, functional status, charlson comorbidity index, ASA classification, BMI classification, and number of vertebral levels operated on during surgery. This matching process led to a final sample of 588 subjects (294 CDA, 294 ACDF). Multivariable regression was performed for five outcome measures: operation time, early complications, reoperation rates, hospital length of stay (HLOS), and discharge destination. Mean differences (B), odds ratios (OR) and associated 95% confidence intervals (CI) are reported. RESULTS: Compared to ACDF, CDA was associated with decreased mean operation time (B=-18.78-min, 95% CI [-29.13, -8.42]; p<0.001), decreased HLOS (B=-0.44-days [-0.77, -0.11]; p=0.009), and increased likelihood of discharge to home (OR=5.39 [1.14-25.43]; p=0.033). No differences in reoperation rates and complications were found. CONCLUSION: In a matched cohort analysis, CDA performs comparably to ACDF and is associated with decreased operation time and HLOS, and increased likelihood of discharge to home, without differences in 30-day complications or reoperation rates. Future prospective studies are warranted. Published by Elsevier Ltd.
OBJECTIVE: Cervical disc arthroplasty (CDA) is a recent alternative to anterior cervical discectomy and fusion (ACDF) in patients suffering cervical disc herniation and degeneration. To date, a systematic analysis of their comparative advantages and risks following elective surgery remains elusive. METHODS: Adult patients undergoing elective CDA or ACDF were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2011-2014. A total of 19,369 patients were matched 1:1 by age, sex, functional status, charlson comorbidity index, ASA classification, BMI classification, and number of vertebral levels operated on during surgery. This matching process led to a final sample of 588 subjects (294 CDA, 294 ACDF). Multivariable regression was performed for five outcome measures: operation time, early complications, reoperation rates, hospital length of stay (HLOS), and discharge destination. Mean differences (B), odds ratios (OR) and associated 95% confidence intervals (CI) are reported. RESULTS: Compared to ACDF, CDA was associated with decreased mean operation time (B=-18.78-min, 95% CI [-29.13, -8.42]; p<0.001), decreased HLOS (B=-0.44-days [-0.77, -0.11]; p=0.009), and increased likelihood of discharge to home (OR=5.39 [1.14-25.43]; p=0.033). No differences in reoperation rates and complications were found. CONCLUSION: In a matched cohort analysis, CDA performs comparably to ACDF and is associated with decreased operation time and HLOS, and increased likelihood of discharge to home, without differences in 30-day complications or reoperation rates. Future prospective studies are warranted. Published by Elsevier Ltd.
Entities:
Keywords:
ACDF; ACS-NSQIP; CDA; Cervical spine; Operation time; Spine surgery
Authors: S Finkenstaedt; A F Mannion; T F Fekete; D Haschtmann; F S Kleinstueck; U Mutter; H J Becker; D Bellut; F Porchet Journal: Eur Spine J Date: 2019-07-08 Impact factor: 3.134
Authors: Abhinaba Chatterjee; Nada Rbil; Michael Yancey; Matthew T Geiselmann; Benjamin Pesante; Sariah Khormaee Journal: N Am Spine Soc J Date: 2022-06-12