Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion in the Treatment of Degenerative Cervical Myelopathy: Patient Characteristics and Surgical Outcomes in a National Administrative Database

Abstract

Study Design: A retrospective cohort utilizing the PearlDiver Patient Claims Database. Objective: Cervical disc arthroplasty (CDA) is accepted treatment for cervical radiculopathy; however, it may also be safe and effective in myelopathy. Thus, we compared clinical characteristics and outcomes in patients undergoing CDA and anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) specifically. Methods: Patients undergoing CDA or ACDF between 2015-2019 were identified with follow-up through 2021. Univariate and multivariable analyses were performed to identify factors associated with either procedure. Reoperation rates were compared using propensity-matched analysis. Results: We identified n = 2391 CDA and n = 50 845 ACDF procedures for DCM. Factors favoring CDA included: female sex, younger age, lower CCI, lower incidence of obesity, osteoporosis, diabetes, or smoking (P ≤ .001); remaining significant after multivariable logistic regression except for sex (P = .06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and multi-level surgery; all remaining significant after multivariable analysis except for diabetes (P = .23) and CCI (P = .05). After propensity-matching CDA and ACDF patients (n = 2391), there was no difference in re-operation rates (P = .47). Conclusions: CDA patients were healthier (less obesity, smoking, diabetes, better CCI) and represented 4.5% of anterior procedures for DCM. In univariate analysis, readmission rates, medical complications, and opioid use were lower in CDA patients, despite a similar reoperation rate. Considering these findings, CDA might be used very selectively for DCM.