Related Experiment Video
Updated: May 25, 2025
Anterior Cervical Discectomy and Fusion in the Ovine Model
Published on: October 5, 2009
Incidence of Multiple Revision Cervical Surgeries After Single-Level Anterior Cervical Discectomy and Fusion
Wesley M Durand1, Amir Human Hoveidaei2, Micheal Raad1
1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
Study Design:
Retrospective analysis using the MarketScan private insurance database from 2010 to 2020.
Objective:
Determine the incidence of multiple revision cervical surgeries at 5 years following primary, single-level anterior cervical discectomy and fusion (ACDF) and assess the risk of subsequent revisions after the first and second surgeries.
Background:
The rate of revision surgery after ACDF is well-documented, but data on multiple revision surgeries are limited.
Materials And Methods:
Adult patients 65 years or younger undergoing primary, single-level ACDF were identified. Patients with infectious, traumatic, or neoplastic etiologies were excluded. The primary endpoint was any revision cervical surgery with follow-up ending at 5 years. Kaplan-Meier and Cox proportional hazards regression were used, adjusting for sex, age, Charlson Comorbidity Index, and region.
Results:
A total of 42,845 patients undergoing primary, single-level ACDF (P) were included, with a mean age of 48.9 years (SD: 9.0); 52.8% were females. The "first revision" (R1) group included 2374 patients, and the "second revision" (R2) group had 195 patients. The mean revision-free follow-up was significantly different across the P, R1, and R2 groups, though with small absolute differences (P 2.2 yr, R1 2.0 yr, R2 2.0 yr; P < 0.0001). At 5 years postoperatively, the incidence of revision surgery was 10.8% after primary surgery, 24.1% after 1 revision, and 42.5% after 2 revisions. In multivariable Cox regression, the risk of subsequent revision surgery was significantly higher after one revision (HR: 1.6 vs . primary, P < 0.0001) and even more so after 2 revisions (HR: 2.6 vs . primary, P < 0.0001). Interval hazard analysis showed a significantly higher incidence of revision from 2 to 5 years with each subsequent revision (all P < 0.05).
Conclusion:
After primary ACDF in patients younger than 65 years, approximately 10% underwent revision at 5 years postoperatively. The occurrence of subsequent revision surgery was higher; >20% after 1 revision, and >40% after 2 revisions, which is critical for patient decision-making.
Level Of Evidence:
Level III.
