Durability of Anterior Cervical Discectomy and Fusion: A Survivorship Analysis Based on Revision Surgery Rates

作者：Charles H. Crawford, Steven D. Glassman, Wyatt T. Ware, Mladen Djurasovic, Roger K. Owens, Jeffrey L. Gum, Leah Y. Carreon · 发表于：Journal of the American Academy of Orthopaedic Surgeons · 年份：2025 · DOI：10.5435/jaaos-d-24-01171 · 被引用次数：2 · 研究领域：Cervical and Thoracic Myelopathy、Spine and Intervertebral Disc Pathology、Scoliosis diagnosis and treatment

INTRODUCTION: Durability of surgical treatment is important to patients, providers, and payers. In addition to the obvious effect on clinical outcomes and satisfaction, durability is an important variable when evaluating cost-effectiveness. The purpose of this study was to analyze the prevalence and indications for revision surgery after anterior cervical discectomy and fusion (ACDF). METHODS: A multisurgeon, single-institution database was queried for revision surgery after ACDF from 2014 to 2018 with a minimum follow-up of 4 years (N = 1,652). Demographic data, surgical data, and primary indication for revision surgery were collected by medical record analysis. All statistical analyses were performed using IBM SPSS v28.0 (IBM). RESULTS: A total of 147 of 1,652 patients (9%) underwent unplanned revision surgery during the study period. The mean patient age was 53.6 years; the mean number of surgical levels was 1.8. The most common indication for revision surgery was nonunion (N = 94, 6%), which occurred at a mean of 33 months postoperatively. The second most common indication was adjacent segment disease (N = 37, 2%), which occurred at a mean of 24 months postoperatively. Patients who had a revision surgery for nonunion had more levels fused (2.06) compared with patients who had no revision surgery (1.65) or had surgery for adjacent segment disease (1.76) ( P < 0.001). Likewise, patients with nonunion had longer surgical time ( P < 0.001) and length of stay ( P = 0.036). Pat...