Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases: a population-based cohort study in Taiwan

Background Context The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. Purpose This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. Study Design This is a retrospective population-based cohort study. Patient Sample Our sample consists of patients who underwent ACDF and LMP treatment. Outcome Measures Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. Methods A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. Results Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03–0.05]) than in those who underwent LMP (0.06 [95% CI: 0.04–0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI: 0.96–2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33–0.51]) than in the ACDF group (0.09 [95% CI: 0.07–0.11]), with adjusted HR of 4.81 (95% CI: 3.46–6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95% CI: 1.40–3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12–9.54, p=.03) was associated with reop risk in the patients who underwent LMP. Conclusions There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.