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Related Experiment Video

Updated: May 10, 2025

Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
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Comparison of Revision Rates Among Patients Undergoing 2-Level ACDF, CDR, and Hybrid Constructs.

Wesley M Durand1, Yesha Parekh1, Sang Hun Lee1

  • 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.

Clinical Spine Surgery
|April 21, 2025
PubMed
Summary

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This study found no significant difference in revision rates for two-level anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or hybrid surgery after five years. However, plated hybrid constructs showed higher revision rates compared to plated ACDF or CDR.

Area of Science:

  • Spine surgery outcomes
  • Cervical spine procedures
  • Arthroplasty and fusion techniques

Background:

  • Multilevel cervical disc replacement (CDR) and hybrid anterior cervical discectomy and fusion (ACDF)/CDR constructs are less studied than single-level CDR.
  • Understanding revision rates is crucial for optimizing surgical treatment strategies.

Purpose of the Study:

  • To compare the 5-year revision surgery rates of two-level ACDF, two-level CDR, and hybrid two-level ACDF/CDR.
  • To evaluate the impact of plating on revision rates in hybrid constructs.

Main Methods:

  • Retrospective analysis of a large commercial insurance database.
  • Inclusion of patients aged 65 or younger undergoing two-level ACDF, CDR, or hybrid surgery.
  • Exclusion of patients with specific etiologies or prior/concomitant posterior surgery; 5-year follow-up for revision rates.
Keywords:
ACDFcervical disc replacementrevision

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Last Updated: May 10, 2025

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Main Results:

  • No significant differences in overall 5-year revision rates were observed between two-level ACDF, CDR, and hybrid ACDF/CDR (10.0%, 10.0%, and 12.4%, respectively).
  • Multivariable analysis indicated no significant differences in revision occurrence between the three surgical groups (P<0.15).
  • Subanalysis revealed higher revision rates for plated hybrid constructs compared to plated ACDF and two-level CDR (HR: 1.5, P=0.0387 and HR: 1.5, P=0.0477, respectively).

Conclusions:

  • Two-level ACDF, CDR, and hybrid ACDF/CDR demonstrate similar 5-year revision rates in patients 65 or younger.
  • Plated hybrid constructs may be associated with an increased risk of revision surgery.
  • Further prospective research is warranted to validate these findings and inform clinical decision-making.