Postoperative adverse events following 2-level hybrid cervical construct relative to 2-level anterior cervical discectomy.

Abstract

ACDF has been the mainstay for managing degenerative cervical spine pathology and CDA has emerged as a possible alternative. Limited research exists comparing postoperative adverse events between 2-level hybrid constructs and 2-level ACDF. To evaluate postoperative adverse events, readmissions, and 5-year survival to reoperation for patients undergoing 2-level cervical hybrid construct (anterior cervical discectomy at 1 level and fusion [ACDF] and cervical disc arthroplasty [CDA] at an adjacent level) relative to 2-level ACDF. Retrospective database study. Patients undergoing 2-level cervical hybrid constructs or 2-level ACDF were isolated from the PearlDiver M165Ortho 2010-2021 database, a large national billing claims database containing de-identified health information across all payer types and sites of care in the US. Incidence of 90-day postoperative adverse events in 2-level cervical hybrid construct patients and 2-level ACDF patients. Relative odds of 90-day adverse events for hybrid construct patients relative to ACDF patients. 5-year survival to reoperation. Two-level cervical hybrid construct and 2-level ACDF patients were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) scores. Odds of 90-day postoperative adverse events were compared between the 2 groups using multivariable analysis. Five-year survival to cervical spine reoperation was then assessed. After matching, there were 1,417 patients in the hybrid construct group and 5,664 in the ACDF group. No significant differences were identified for 90-day individual adverse events, aggregated any adverse events, or readmissions. Further, no significant difference was identified for 5-year survival to reoperation. While consideration may be given to 2-level cervical hybrid constructs or 2-level ACDF, the current large-cohort comparison study could not determine differences in 90-day complications or 5-year reoperations between these surgical options to support 1 procedure over the other.