Comparisons of Safety and Clinical Outcomes Between Multiple-level and Single-level Cervical Disk Replacement for Cervical Spondylosis

Jiang, Lianghai; Tan, Mingsheng; Yang, Feng; Yi, Ping; Tang, Xiuwen; Hao, Qingying

doi:10.1097/bsd.0000000000000399

Cited by 7 publications

(9 citation statements)

References 31 publications

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“…These results could be because both cohorts have similar comorbidities overall. Our outcomes are consistent with previous literature that found no significant 30-day complications between inpatient versus outpatient CDR20,25–27 as well as studies that found no significant differences in 90-day complications between single versus multiple outpatient CDR 21…”

Section: Discussionsupporting

confidence: 92%

“…With outpatient CDR gaining greater popularity as a treatment option for cervical pathologies requiring disk replacement, understanding the efficacy and safety of this outpatient procedure is necessary. Prior studies have investigated 30-day complication rates and found no significant differences in complication rates between patients who receive a single-level or multiple-level CDR in the inpatient setting compared with the outpatient setting 20,25–27. One study looking at 90-day complication rates of outpatient CDR only compared single-level outpatient CDR to multiple-level outpatient CDR without comparing the groups to inpatient CDR cohorts 27.…”

Section: Discussionmentioning

confidence: 99%

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No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or Multiple-level Cervical Disk Replacement for Cervical Radiculopathy

Ifarraguerri

Malyavko

Stoll

et al. 2022

Spine

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Study Design. Retrospective cohort analysis. Objective. To investigate the safety profile of outpatient versus inpatient single-level and multiple-level cervical disk replacement (CDR) by analyzing one-and two-year surgical outcomes and 90-day medical complications using a large patient database. Summary of Background Data. CDR is becoming a more desirable option for patients undergoing cervical spine procedures. Unlike anterior cervical diskectomy and fusion, CDR is motionpreserving and has been shown to reduce rates of adjacent segment disease. Current literature investigating outpatient versus inpatient CDR has shown a similar safety profile among the two cohorts. However, most of these studies have relatively small sample sizes with short-term follow-up. Materials and Methods. A retrospective cohort study was done using the PearlDiver patient database between 2010 and 2019. Patients who underwent single-level and multiple-level CDR with a follow-up of at least two years were identified. Patients within each procedure cohort were subdivided into an outpatient and an inpatient group. Univariate and multivariable analyses were performed. Results. In total, 2294 patients underwent single-level CDR of which 506 patients underwent outpatient CDR and 1788 underwent inpatient CDR. In total, 236 patients underwent multiple-level CDR of which 49 patients underwent outpatient CDR and 187 underwent inpatient CDR. In the single-level CDR cohort, patients undergoing outpatient CDR were found to have lesser odds of a decompressive laminectomy at one year following the initial procedure (odds ratio = 0.471; 95% confidence interval. 0.205-0.945; P = 0.05). No significant differences in one-and two-year surgical complications, or 90-day postoperative complications, were found on multivariate analysis of outpatient versus inpatient multiple-level CDR. Conclusion. Our study found that performing single-level and multiple-level CDR on an outpatient basis has a similar safety profile to patients who underwent these procedures in an inpatient setting.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or Multiple-level Cervical Disk Replacement for Cervical Radiculopathy

Ifarraguerri

Malyavko

Stoll

et al. 2022

Spine

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“…The posterior approach was technically easier and allows decompression of the entire cervical spine [13]. In the multiple levels of cervical spondylosis with myelopathy patients who fail with conservative treatment, the choices of operative treatment may be anterior or posterior surgical management [20]. The spinal surgeons should be concerned about post-operative cervical kyphosis or postoperative loss of lordosis.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Analysis Comparison of Cervical Alignment After Variable Level of Anterior Cervical Discectomy and Fusion (ACDF)

Sornsa-ard¹,

Sribunditkul²,

Vasutara³

et al. 2020

Hong Kong J Orthop Res

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Background: To compare the radiographic cervical lordosis alignment between pre-operative and post-operative surgery after variable level of anterior cervical discectomy and fusion (ACDF) .In the current review, the standard surgical treatment of cervical spondylotic myelopathy is ACDF the restoration and maintenance of cervical lordosis alignment is an important clinical parameter after single level or multilevel anterior cervical discectomy and fusion. The increase or decrease cervical lordosis alignment is affected by the sagittal vertical axis and balance. Methods: This study was performed a retrospective radiographic analysis of 147 patients who underwent single to multilevel ACDF (Total N= 147; 1-level (N=36), 2-level (N=60), 3-level (N=42) and 4-level (N=9)) by orthopedic spine surgeons and neurosurgeons between 2016 and 2018. The authors measured the cervical lordosis alignment of the cervical spine using the Cobb method (Inferior endplate of C2 to inferior endplate of C7) at pre-operative and post-operative surgery. Radiographs were measured by three orthopedic doctor viewers. Statistical analysis were performed using R software. Results: The radiographic analysis comparison of cervical alignment after ACDF was showed the results that cervical lordosis alignment had no significantly change of decreased cervical lordosis alignment at pre-op mean 14.88°(± 8.66) and initial post-op mean 13.01°(±7.65) in all level of ACDF. Conclusions: The radiographic analysis of variable level anterior cervical discectomy and fusion in single to multilevel (1-level, 2-level, 3-level and 4-level) has no significantly change in cervical lordosis alignment after initial postop surgery.

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“…55 These additional complications were not reported under AEs in each RCT, and were therefore not discussed in the present review. 3,56…”

Section: Discussionmentioning

confidence: 99%

“…55 These additional complications were not reported under AEs in each RCT, and were therefore not discussed in the present review. 3,56 Methods Clarity and Results Quality Quantifying the risk for AEs following CDA is essential to both patients and surgeons during the informed consent process. Heterogeneity in the quality and clarity of AE reporting has been documented in other spinal surgery cohorts.…”

Section: Anderson Et Al (2008) Bryanmentioning

confidence: 99%

Adverse Events Following Cervical Disc Arthroplasty: A Systematic Review

Goel

Shriver

et al. 2017

Global Spine Journal

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Study Design:Systematic review.Objectives:Cervical arthroplasty is an increasingly popular treatment of cervical radiculopathy and myelopathy. An understanding of the potential adverse events (AEs) is important to help both clinicians and patients. We sought to provide a comprehensive systematic review of the AEs reported in all randomized controlled trials (RCTs) of cervical disc arthroplasty in an attempt to characterize the quality of reporting.Methods:We conducted a systematic review of MEDLINE and Web of Science for RCTs of cervical disc arthroplasty reporting AEs. We reported the most frequently mentioned AEs, including dysphagia/dysphonia, vascular compromise, dural injury, and infections. We recorded the presence of industry funding and scored the quality of collection methods and reporting of AEs.Results:Of the 3734 identified articles, 29 articles met full inclusion criteria. The quality of AE reporting varied significantly between studies, and a combined meta-analysis was not feasible. The 29 articles covered separate 19 RCTs. Eight studies were US Food and Drug Administration (FDA) investigational device exemption (IDE) trials. Rates were recorded for the following AEs: dysphagia/dysphonia (range = 1.3% to 27.2%), vascular compromise (range = 1.1% to 2.4%), cervical wound infection (range = 1.2% to 22.5%), and cerebrospinal fluid leak (range = 0.8% to 7.1%).Conclusions:There is a lack of consistency in reporting of AEs among RCTs of cervical arthroplasty. FDA IDE trials scored better in AE event reporting compared to other studies. Standardized definitions for AEs and standardized data collection methodology are needed to improve future studies.

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Comparisons of Safety and Clinical Outcomes Between Multiple-level and Single-level Cervical Disk Replacement for Cervical Spondylosis

Cited by 7 publications

References 31 publications

No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or Multiple-level Cervical Disk Replacement for Cervical Radiculopathy

No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or Multiple-level Cervical Disk Replacement for Cervical Radiculopathy

Radiographic Analysis Comparison of Cervical Alignment After Variable Level of Anterior Cervical Discectomy and Fusion (ACDF)

Adverse Events Following Cervical Disc Arthroplasty: A Systematic Review

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