Reoperation Risk Between Plated and Stand-Alone Anterior Cervical Discectomy and Fusion

Study Design. Retrospective cohort study. Objective. Anterior cervical discectomy and fusions (ACDF) have become a common and effective means of decompression and stabilization of the cervical spine. Anterior instrumentation with plates and screws (ACDF-P) are increasingly utilized to increase rates of union. However, concerns with plate-related risks have led to the evolution of stand-alone ACDF (ACDF-S) constructs in hopes of reducing adjacent segment degeneration from plate prominence though critics have pointed out potential for subsidence, instability, and nonunions. We sought to evaluate reoperation risk following ACDF-S compared with ACDF-P in a multicenter US-based cohort. Summary of Background Data. Adult patients who underwent primary one to two-level ACDF between C3 and C7 for degenerative disc disease were identified using a health care system’s spine registry (2009–2022). Three thousand nine hundred fifty-eight ACDF comprised the final study sample, 278 (7.0%) were ACDF-S. Procedures were performed by 59 surgeons at 16 hospitals. Methods. Multivariable Cox proportional-hazards regression was used to evaluate ACDF-S versus ACDF-P and risk of reoperation for any cause with confounder adjustment. Reoperation for adjacent segment disease (ASD) or nonunion were also evaluated. Secondary analysis stratified by one and two-level ACDF procedures. Results. In adjusted analyses, no differences in all-cause reoperation risk [hazard ratio (HR)=0.97, 95% CI=0.58–1.64] or reoperation for ASD (HR=1.11, 95% CI=0.61–1.99) was observed when comparing ACDF-S to ACDF-P. No differences in reoperation risks were also found when restricted to one-level procedures (all-cause: HR=0.92, 95% CI=0.50–1.68; ASD: HR=0.88, 95% CI=0.44–1.78). For two-level procedures, there were 49 ACDF-S and 1,886 ACDF-P. There were too few events observed for regression analysis. Conclusions. In this large, comparative study including a cohort of nearly 4000 patients, differences in reoperation rates for ACDF-S compared with ACDF-P constructs were not observed. This information could be used to better inform surgeons, patients, administrators, and policy makers between the 2 ACDF options.