J Am Acad Orthop Surg. 2025 Jun 17. doi: 10.5435/JAAOS-D-24-01171. Online ahead of print.
ABSTRACT
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). Patients who underwent a revision surgery for adjacent segment disease had a higher body mass index (BMI = 33.6) compared with patients without revision surgery (BMI = 30.4) or patients who underwent revision surgery for nonunion (BMI = 31.2) (P = 0.012). Comorbidities as measured by ASA grade did not differ between groups (P = 0.633). Smoking status, use of anterior plate, and use of structural allograft did not differ between groups (P > 0.05). No other differences were found among these groups. Other indications for revision surgery were much less common (<1%) and included evacuation of hematoma (N = 5), repeat decompression (N = 5), infection (N = 2), extension into the thoracic spine (N = 2), and implant reposition (N = 2).
DISCUSSION: ACDF is a relatively durable procedure (91%) as currently indicated and performed in a large multisurgeon spine center. Early revision surgery (<90 days) for hematoma or infection is rare. Late revision surgery (>90 days) for nonunion is more than twice as common as adjacent segment disease and occurred earlier and more commonly when a greater number of levels were fused. These data can help guide clinicians and researchers in future quality improvement initiatives.
PMID:40526909 | DOI:10.5435/JAAOS-D-24-01171
