स्पाइन जर्नल

Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion; Utilization and Perioperative Outcomes

Abstract

Vadim Goz, Jeffrey H Weinreb, Kai Dallas, Ian McCarthy, Justin Paul, Themistocles Protopsaltis, Jeffrey Goldstein, Virginie Lafage and Thomas J Errico

Summary of Background Data: Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical intervention for cervical degenerative disc disease (DDD). Cervical disc arthroplasty (CDA) has been introduced as an alternative. CDA offers the potential advantage of preserving intersegmental motion and preventing adjacent segment degeneration. Although a number of trials demonstrated non-inferiority of CDA compared to ACDF in terms of symptom/function related outcomes, little data is available comparing perioperative outcomes.

Methods: The Natiowide Inpatient Sample (NIS) database was queried for ACDFs or CDAs between 2005 and 2010. Univariate analyses was used comparing the two procedures in terms of patient demographics, comorbidities, perioperative complications, length of stay (LOS), total hospital charges, and mortality. Complications rates that were significant on univariate analysis were analyzed via logistic regression models that account for age, gender, and overall comorbidity burden. National estimates of annual total number of procedures were calculated.

Results: An estimated 9,910 CDAs and 699,289 ACDFs were performed in the United States between 2005 and 2010. The CDA cohort was younger and with less comorbidities than the ACDF cohort. The CDA cohort experienced less post-operative dysphagia, hematoma, acute anemia secondary to intraoperative blood loss, or ARDS. ACDF was associated with less cardiac complications, peripheral vascular, and device related complications. All complications remained statistically significant in logistic regression models. CDA had a lower average LOS (1.56 versus 2.23 days, p<.0001) and was associated with less total charges ($39,563 versus $43,477, p<.0001). Mortality was lower after CDA (0.10% versus 0.22%, p=.01).

Conclusions: This data suggests that CDA may be safer, associated with lower mortality, lower hospital charges and shorter LOS compared to ACDF. However, baseline differences between the two cohorts, including age and comorbidity burden, may play a confounding role in these findings. This information could be important in developing an evidence-based paradigm for surgical management of cervical DDD.