Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

Abstract

Purpose: To evaluate rates of secondary surgical interventions in a cohort treated with fusion (ACDF), artificial disc replacement (ADR) or a posterior surgical procedure (PP) because of a cervical degenerative pathology. Methods: 715 patients treated with any primary cervical surgical intervention between the years 2000 and 2010 were retrospectively evaluated regarding frequency of secondary surgery between the years 2000 and 2015, thus giving a follow-up time of minimum 5 years. Reasons for secondary surgery as well as choice of new intervention were evaluated. Data were collected from a single-center setting. Results: Follow-up rate was 94%. 79 (11%) patients in total underwent a new operation during follow-up. 50/504 (10%), 27/172 (15%), and 2/39 (5%) of the patients had a second surgical intervention in the ACDF, ADR, and PP groups, respectively. There was a statistically significant higher rate of repeated surgery in the ADR group compared to the ACDF group, OR 1.7 (CI 1.06–2.8), p = 0.03. Risk for repeated surgery at index level was even higher for ADR, OR 5.1 (CI 2.4–10.7), p < 0.001. Reoperation rate because of ASD in the whole cohort did not differ between ACDF and ADR groups, p = 0.40. Conclusion: The group initially treated with artificial disc replacement showed higher rate of reoperations and more implant-related complications. In this cohort, artificial disc replacement was not protective against reoperation because of adjacent segment pathology.