Should We Re-Instrument the Originally Fused Level in ACDF Revision for Adjacent Segment Disease?: A Quality Outcomes...

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Adjacent segment disease (ASD) is a common complication after anterior cervical discectomy and fusion (ACDF).
• Re-instrumentation of the original fused segment offers greater biomechanical stability.
• Limited research compares outcomes of re-instrumentation versus adjacent segment fusion in revision ACDF.

Purpose of the Study:

• To compare perioperative variables, patient-reported outcomes, and reoperation rates.
• Investigate outcomes between re-instrumentation of the original fused level and fusion of the adjacent segment alone in revision ACDF.

Main Methods:

• Retrospective cohort study of revision ACDF patients from the Quality Outcome Database.
• Primary exposure: re-instrumentation of the original segment.
• Outcomes assessed: perioperative variables, reoperation rates, and PROMs (pain, NDI, EQ-5D, mJOA) at various time points.

Main Results:

• Re-instrumentation group had higher blood loss, operative time, and hospital stay.
• No significant differences in neck/arm pain, NDI, or mJOA scores between groups at 3, 12, or 24 months.
• Reoperation rates at 3 and 12 months were comparable between the two groups.

Conclusions:

• Comparable PROMs and reoperation rates suggest avoiding re-instrumentation when feasible.
• Opting for conservative single-level revision may minimize risks associated with increased perioperative complications.
• Surgeons should consider conservative approaches to reduce blood loss, operative time, and length of stay.