Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Comparison of National Trends and Outcomes

Ostrov, Philip B; Reddy, Abhinav K.; Ryoo, James S; Behbahani, Mandana; Mehta, Ankit I.

doi:10.1016/j.wneu.2021.12.099

Cited by 7 publications

(8 citation statements)

References 37 publications

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“…Similarly, past studies have found regional differences in CDA utilization compared with ACDF, 31 a finding that may be due to variations in regional practices. In addition, commercial insurance was an independent predictor of receiving CDA as opposed to ACDF, as reported by prior studies 29,32 . This may be attributable to differential authorization/approval processes, suggesting potential disparities in care.…”

Section: Discussionsupporting

confidence: 62%

“…Controversy exists regarding the differential utilization of CDA versus ACDF for the surgical management of singlelevel cervical pathology. [26][27][28] Although past studies have evaluated trends in the utilization of CDA relative to ACDF up to 2015, 29 no studies have compared the utilization of these procedures in more recent years. The current study assessed trends in CDA relative to ACDF from 2010 to 2021, predictive factors for receiving one procedure versus the other, as well as relative 5-year survival to reoperation.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, commercial insurance was an independent predictor of receiving CDA as opposed to ACDF, as reported by prior studies. 29,32 This may be attributable to differential authorization/approval processes, suggesting potential disparities in care. Finally, having surgery performed by an orthopedic surgeon rather than by a neurosurgeon was found to increase the odds of having CDA.…”

Section: Discussionmentioning

confidence: 99%

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Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021

Ratnasamy¹,

Rudisill²,

Maloy³

et al. 2022

Spine

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Study Design. Descriptive epidemiologic study. Objective. To compare trends in utilization and predictive factors for single-level cervical disc arthroplasty (CDA) relative to anterior cervical discectomy and fusion (ACDF) over the years. Background. CDA is an alternative to ACDF for the treatment of cervical spine pathologies. With both procedures performed for similar indications, controversy on best practices exists. Materials and Methods. Patients who underwent single-level CDA or ACDF were identified in the 2010 through 2021 PearlDiver M151Ortho data set. The yearly number of CDAs performed and proportionality was assessed. Predictive patient factors for undergoing CDA as opposed to ACDF were determined. Kaplan Meyer survival analysis with an endpoint of cervical spine reoperation compared 5-year outcomes between CDA and ACDF. Results. From 2010 to 2021, 19,301 single-level CDAs and 181,476 single-level ACDFs were identified. The proportional utilization of CDA relative to ACDF increased from 4.00% in 2010 to 14.15% in 2018 (P < 0.0001), after which there was a plateau between 2018 and 2021 where proportional utilization was 14.47% (P = 0.4654). Multivariate analysis identified several predictors of undergoing CDA rather than ACDF, including: younger age [odds ratio (OR) per decade decrease: 1.72], having surgery performed in the Midwest, Northeast, or West (relative to South, OR: 1.16, 1.13, 2.26, respectively), having Commercial insurance (relative to Medicare, OR: 1.75), and having surgery performed by an orthopedic surgeon (relative to a neurological surgeon, OR: 1.54) (P < 0.0001 for each). There was no statistically significant difference in 5-year survival to further cervical spine surgery between CDA and ACDF at 5 years (97.6% vs. 97.7%, P = 0.4249). Conclusions. Although the use of CDA relative to ACDF rose from 2010 to 2018, its use has subsequently plateaued between 2018 and 2021 and remained a relatively low percentage of the single-level anterior cervical surgeries performed (14.47% in 2021). The causes for such changes in the trend are unclear.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021

Ratnasamy¹,

Rudisill²,

Maloy³

et al. 2022

Spine

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“…ACDF is regarded as the standard surgical procedure for CDDD. 119 However, in addition to the common complications of ACDF, there are rare but disastrous complications, such as esophageal tear, pharyngeal perforation, and even expectoration of the entire ACDF construct. 120 Moreover, several publications showed that changes in the biomechanical of adjacent segments after ACDF may result in adjacent segment degeneration (ASD).…”

Section: Discussionmentioning

confidence: 99%

“… 125 Compared with ACDF, CDA was superior or equivalent in terms of length of stay (LOS), clinical indicators, range of motion (ROM) of the cervical spine, adverse events, and reoperation rates. 29 , 97 , 109 , 126 Although CDA has some advantages over ACDF in surgical outcomes, the indications of CDA are relatively narrow, the procedure is more complex, 117 , 119 and the financial requirements of patients are higher, 127 all of which limit the application of CDA in the clinic. Some scholars believe that postoperative complications of CDA, such as heterotopic ossification (HO), osteolysis, and aseptic loosening caused by abrasion, spontaneous fusion, and postoperative hematoma, are also one of the factors limiting its wide application.…”

Section: Discussionmentioning

confidence: 99%

A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion

Wang¹,

Lin²,

Wang³

et al. 2022

JPR

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Study design: A bibliometric analysis.Objective: To identify and analyze the top 100 cited articles in anterior cervical discectomy and fusion. Summary of Background Data: Anterior cervical discectomy and fusion (ACDF) is one of the most routine surgical procedures in spine surgery. Many surgeons and academics have researched ACDF thoroughly and published numerous articles. However, there is no relevant bibliometric analysis. Therefore, our study aims to identify and analyze the top 100 cited articles in ACDF to identify the research trends. Methods: We searched the Web of Science (WOS) Core Collection database with restrictions and identified the top 100 cited publications in ACDF for analysis. Results:The citation counts of the top 100 cited publications ranged from 37 to 361 (mean 67.42). All studies were published between 2008 and 2019, with 2013 and 2015 the most prolific years. The journals Spine and Journal of Neurosurgery-Spine provided the majority of the articles. Overall, the 100 articles came from 12 countries, with the United States being the top producer, followed by China and South Korea. The most frequent keywords were "spine", "anterior cervical discectomy and fusion", "interbody fusion", 'arthrodesis', "follow-up", "decompression", and "ACDF". Conclusion: ACDF has been regarded as a classical gold standard in anterior cervical surgery, and the emergence of new surgical procedures has not affected its status. Cervical disc arthroplasty still needs further research and development. As the first bibliometric analysis of ACDF, this bibliometric study is meant to provide guidance for clinicians and scholars to research the development trend of this field.

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