Reoperation Risk Between Plated and Stand-Alone Anterior Cervical Discectomy and Fusion: A National Spine...

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical spine issues.
• Anterior instrumentation with plates and screws (ACDF-P) is widely used to enhance fusion rates.
• Stand-alone ACDF (ACDF-S) has emerged as an alternative, aiming to reduce adjacent segment degeneration, but concerns about subsidence and nonunion exist.

Purpose of the Study:

• To compare the risk of reoperation between ACDF-S and ACDF-P.
• To evaluate reoperation for adjacent segment disease (ASD) and nonunion between the two techniques.
• To provide data for informed decision-making regarding ACDF-S versus ACDF-P.

Main Methods:

• Retrospective cohort study of adult patients undergoing primary one to two-level ACDF (C3-C7) for degenerative disc disease.
• Analysis of a multicenter US-based spine registry (2009-2022) including 3,958 patients (278 ACDF-S).
• Multivariable Cox proportional-hazards regression to assess reoperation risk, adjusted for confounders, with secondary analysis stratified by procedure level.

Main Results:

• No significant difference in all-cause reoperation risk was found between ACDF-S and ACDF-P (HR=0.97).
• Reoperation risk for adjacent segment disease (ASD) was also similar between the two groups (HR=1.11).
• No differences were observed for one-level procedures; insufficient data for regression analysis in two-level ACDF-S.

Conclusions:

• This study found no significant difference in reoperation rates between ACDF-S and ACDF-P constructs in a large patient cohort.
• The findings suggest that both ACDF-S and ACDF-P have comparable reoperation risks.
• This evidence can assist surgeons, patients, and policymakers in choosing between ACDF-S and ACDF-P.