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Incidence of Multiple Revision Cervical Surgeries After Single-Level Anterior Cervical Discectomy and Fusion

  • 0Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Spine +

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February 28, 2025

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February 28, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Revision rates after anterior cervical discectomy and fusion (ACDF) increase significantly with each subsequent surgery. Patients under 65 face over 40% risk of a third surgery after two prior revisions.

Area Of Science

  • Spine surgery outcomes
  • Cervical spine research
  • Surgical revision epidemiology

Background

  • The rate of revision surgery following anterior cervical discectomy and fusion (ACDF) is documented, but data on multiple revisions is scarce.
  • Understanding the cumulative risk of revision surgery is crucial for patient counseling and surgical planning.

Purpose Of The Study

  • To determine the incidence of multiple revision cervical surgeries within five years of a primary, single-level ACDF.
  • To assess the escalating risk of subsequent revisions after the first and second revision surgeries.

Main Methods

  • Retrospective analysis of the MarketScan private insurance database (2010-2020).
  • Inclusion of adult patients (≤65 years) undergoing primary, single-level ACDF, excluding infectious, traumatic, or neoplastic cases.
  • Kaplan-Meier and Cox proportional hazards regression analysis, adjusting for relevant covariates.

Main Results

  • A total of 42,845 patients were analyzed; 10.8% underwent a first revision, and 2.1% underwent a second revision within five years.
  • The cumulative incidence of revision surgery at five years was 10.8% after primary ACDF, 24.1% after one revision, and 42.5% after two revisions.
  • The risk of subsequent revision was significantly higher after one revision (HR 1.6) and markedly higher after two revisions (HR 2.6) compared to primary surgery.

Conclusions

  • Approximately 10% of patients under 65 require revision surgery within five years of primary ACDF.
  • The risk of further revision escalates substantially, with over 20% requiring a second revision and over 40% needing a third after two prior revisions.
  • These findings are critical for informing patient decision-making regarding ACDF and potential repeat surgeries.