Migraines as a Risk Factor for Many 90-Day Postoperative Complications Following Single-Level Anterior Cervical Diskectomy and Fusion.

Abstract

Anterior cervical diskectomy and fusion (ACDF) is a common spinal surgery for which patient factors may be associated with adverse outcomes. One such potential predisposing risk factor is a history of migraines. The relationship between migraines and postoperative adverse outcomes following ACDF procedures has not been studied. Appreciating such correlations may aid in patient counseling and care pathways. Using the 2015-Q3 2022 PearlDiver Mariner161 database, adult patients undergoing single-level ACDF were identified. Patients who underwent concomitant spinal procedures and patients presenting with a spine infection, trauma, or neoplasm were excluded. Four-to-one matching was conducted for patients without versus with history of migraines based on age, sex, and Elixhauser Comorbidity Index.Ninety-day postoperative adverse events were then characterized, including individual and aggregated events, as well as emergency department visits, and compared for the matched populations with multivariate logistic regression analyses. Five-year occurrences of subsequent cervical spine surgeries were compared using a log-rank test and plotted by Kaplan-Meier survival curves. Of the 326,722 ACDF patients studied, history of migraines was identified for 16,434 (5.03%). After matching, there were 14,774 patients with migraines and 58,820 patients without migraines.Following ACDF surgery, those with a history of migraines had independently higher odds ratios of experiencing most individual 90-day adverse outcomes, as well as any (OR: 2.53), severe (OR: 2.35), and minor (OR: 2.47) adverse events and emergency department visits (OR: 3.42; P < 0.0001). Those with migraines did not have different rates of subsequent cervical spine surgery out to 5 years. ACDF patients with a history of migraines were found to have higher rates of most 90-day postoperative adverse outcomes assessed. As such, patients with migraines ought to receive supplemental risk counseling and postoperative resource planning when undergoing ACDF surgery. Nonetheless, it was reassuring that 5-year revision surgeries were not significantly different for those with versus without history of migraines.