European Spine Journal

, Volume 27, Issue 6, pp 1432–1439 | Cite as

Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases

  • Michael P. Kelly
  • Claire D. Eliasberg
  • Max S. Riley
  • Remi M. Ajiboye
  • Nelson F. SooHoo
Original Article



The aim of this study was to analyze rates of perioperative complications and subsequent cervical surgeries in patients treated for cervical degenerative disc disease with anterior cervical discectomy and fusion (ACDF) and those treated with artificial cervical disc arthroplasty (ACDA) for up to 5-year follow-up.


California’s Office of Statewide Health Planning and Development discharge database was analyzed for patients aged 18–65 years undergoing single-level ACDF or ACDA between 2003 and 2010. Medical comorbidities were identified with CMS-Condition Categories. Readmissions for short-term complications of the procedure were identified and rates of subsequent cervical surgeries were calculated at 90-day and 1-, 3-, and 5-year follow-up. Multivariate regression modeling was used to identify associations with complications and subsequent cervical surgeries correcting for patient and provider characteristics.


A total of 52,395 eligible cases were identified: 50,926 ACDF and 1469 ACDA. Readmission was less common in the ACDA group (OR: 0.69, 95% CI: 0.48–1.0, p = 0.048). Subsequent cervical spine surgery was more common in the ACDF group in the immediate perioperative period (within 90 days of surgery) (ACDF 3.35% vs. ACDA 2.04%, OR: 0.63, 95% CI: 0.44-0.92, p = 0.015). At 1-, 3-, and 5-year postoperatively, rates of subsequent cervical surgeries were similar between the two cohorts.


We found no protective benefit for ACDA versus ACDF for single-level disease at up to 5-year follow-up in the largest cohort of patients examined to date. Early complications were rare in both cohorts stressing the value of large cohort studies to study risk factors for rare events.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Artificial disc Cervical degenerative disc disease Reoperations Spinal fusion Total disc arthroplasty 



This study was funded by a grant from the Cervical Spine Research Society.

Compliance with ethical standards

Conflicts of Interest

Michael P. Kelly has received support from the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and has received grants from AO North America (AONA) Spine, Orthopaedic Research and Education Foundation (OREF), Cervical Spine Research Society (CSRS), Barnes Jewish Foundation, and Fox Family Foundation. Nelson F. SooHoo has previously been supported by CSRS. For the remaining authors, no conflicts of interest or sources of funding were declared. The devices that are the subject of this manuscript are FDA approved for this indication. The Committee for the Protection of Human Subjects (CPHS) has reviewed and approved this project (Project Number: 12-08-0514). This approval is issued under the California Health and Human Services Agency’s Federalwide Assurance #00000681. This study received direct support from the CSRS.

Supplementary material

586_2018_5570_MOESM1_ESM.pptx (149 kb)
Supplementary material 1 (PPTX 148 kb)


  1. 1.
    Rao RD, Currier BL, Albert TJ, Bono CM, Marawar SV, Poelstra KA, Eck JC (2007) Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management. The J Bone Joint Surg Am 89(6):1360–1378CrossRefPubMedGoogle Scholar
  2. 2.
    Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE (2015) Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis. The Spine J 15(9):2016–2027. CrossRefPubMedGoogle Scholar
  3. 3.
    Garrido BJ, Wilhite J, Nakano M, Crawford C, Baldus C, Riew KD, Sasso RC (2011) Adjacent-level cervical ossification after Bryan cervical disc arthroplasty compared with anterior cervical discectomy and fusion. The J bone Joint surg Am 93(13):1185–1189. CrossRefPubMedGoogle Scholar
  4. 4.
    Rosenthal BD, Nair R, Hsu WK, Patel AA, Savage JW (2016) Dysphagia and dysphonia assessment tools after anterior cervical spine surgery. Clin spine surg. PubMedGoogle Scholar
  5. 5.
    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. The J Bone Joint Surg Am 81(4):519–528CrossRefPubMedGoogle Scholar
  6. 6.
    Lee JC, Lee SH, Peters C, Riew KD (2014) Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1358 patients. The J Bone Joint Surg Am 96(21):1761–1767. CrossRefPubMedGoogle Scholar
  7. 7.
    Anderson PA, Sasso RC, Hipp J, Norvell DC, Raich A, Hashimoto R (2012) Kinematics of the cervical adjacent segments after disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis. Spine 37(22 Suppl):S85–S95. CrossRefPubMedGoogle Scholar
  8. 8.
    Kelly MP, Mok JM, Frisch RF, Tay BK (2011) Adjacent segment motion after anterior cervical discectomy and fusion versus prodisc-c cervical total disk arthroplasty: analysis from a randomized, controlled trial. Spine 36(15):1171–1179. CrossRefPubMedGoogle Scholar
  9. 9.
    Skeppholm M, Olerud C (2013) Comparison of dysphagia between cervical artificial disc replacement and fusion: data from a randomized controlled study with two years of follow-up. Spine 38(24):E1507–E1510. CrossRefPubMedGoogle Scholar
  10. 10.
    Delamarter RB, Zigler J (2013) Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial. Spine 38(9):711–717. CrossRefPubMedGoogle Scholar
  11. 11.
    Zhong ZM, Zhu SY, Zhuang JS, Wu Q, Chen JT (2016) Reoperation after cervical disc arthroplasty versus anterior cervical discectomy and fusion: a meta-analysis. Clin Orthop Relat Res. PubMedPubMedCentralGoogle Scholar
  12. 12.
    Zigler JE, Delamarter R, Murrey D, Spivak J, Janssen M (2013) ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single-level cervical symptomatic degenerative disc disease: five-year results of a food and drug administration study. Spine 38(3):203–209. CrossRefPubMedGoogle Scholar
  13. 13.
    Janssen ME, Zigler JE, Spivak JM, Delamarter RB, Darden BV, Kopjar B (2015) ProDisc-c total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized us food and drug administration investigational device exemption study. The J Bone Joint Surg Am 97(21):1738–1747. CrossRefPubMedGoogle Scholar
  14. 14.
    Singh K, Phillips FM, Park DK, Pelton MA, An HS, Goldberg EJ (2012) Factors affecting reoperations after anterior cervical discectomy and fusion within and outside of a Federal Drug Administration investigational device exemption cervical disc replacement trial. The Spine J 12(5):372–378. CrossRefPubMedGoogle Scholar
  15. 15.
    Gornet MF, Schranck FW, Copay AG, Kopjar B (2016) The effect of workers’ compensation status on outcomes of cervical disc arthroplasty: a prospective, comparative, observational study. The J Bone Joint Surg Am 98(2):93–99. CrossRefPubMedGoogle Scholar
  16. 16.
    Narain AS, Hijji FY, Yom KH, Kudaravalli KT, Singh K (2017) Cervical disc arthroplasty: do conflicts of interest influence the outcome of clinical studies? The Spine J 17(7):1026–1032. CrossRefPubMedGoogle Scholar
  17. 17.
    Mehrotra A, Sloss EM, Hussey PS, Adams JL, Lovejoy S, SooHoo NF (2013) Evaluation of a center of excellence program for spine surgery. Med Care 51(8):748–757. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Jee YM, Bak JS, Weinlander E, Anderson PA (2016) Comparing nonrandomized observational studies with randomized controlled trials in cervical disc arthroplasty: a meta-analysis. Spine 41(5):419–428. CrossRefPubMedGoogle Scholar
  19. 19.
    Riew KD, Schenk-Kisser JM, Skelly AC (2012) Adjacent segment disease and C-ADR: promises fulfilled? Evidence-Based Spine-Care J 3(S1):39–46. Google Scholar
  20. 20.
    Anderson PA, Nassr A, Currier BL, Sebastian AS, Arnold PM, Fehlings MG, Mroz TE, Riew KD (2017) Evaluation of adverse events in total disc replacement: a meta-analysis of fda summary of safety and effectiveness data. Global Spine J 7(1 Suppl):76S–83S. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Phillips FM, Geisler FH, Gilder KM, Reah C, Howell KM, McAfee PC (2015) Long-term outcomes of the US FDA IDE prospective, randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. Spine 40(10):674–683. CrossRefPubMedGoogle Scholar
  22. 22.
    Sundseth J, Fredriksli OA, Kolstad F, Johnsen LG, Pripp AH, Andresen H, Myrseth E, Muller K, Nygaard OP, Zwart JA, NORCAT group (2017) The Norwegian Cervical Arthroplasty Trial (NORCAT): 2-year clinical outcome after single-level cervical arthroplasty versus fusion-a prospective, single-blinded, randomized, controlled multicenter study. Eur Spine J 26(4):1225–1235. CrossRefPubMedGoogle Scholar
  23. 23.
    Arrojas A, Jackson JB 3rd, Grabowski G (2017) Trends in the treatment of single and multilevel cervical stenosis: a review of the american board of orthopaedic surgery database. The J Bone Joint Surg Am 99(18):e99. CrossRefPubMedGoogle Scholar
  24. 24.
    Jackson RJ, Davis RJ, Hoffman GA, Bae HW, Hisey MS, Kim KD, Gaede SE, Nunley PD (2016) Subsequent surgery rates after cervical total disc replacement using a mobi-c cervical disc prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up. J neurosurg Spine. Google Scholar
  25. 25.
    Phillips FM, Lee JY, Geisler FH, Cappuccino A, Chaput CD, DeVine JG, Reah C, Gilder KM, Howell KM, McAfee PC (2013) A prospective, randomized, controlled clinical investigation comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. 2-year results from the US FDA IDE clinical trial. Spine 38(15):E907–E918. CrossRefPubMedGoogle Scholar
  26. 26.
    Luo J, Gong M, Huang S, Yu T, Zou X (2015) Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies. Arch Orthop Trauma Surg 135(2):155–160. CrossRefPubMedGoogle Scholar
  27. 27.
    Verma K, Gandhi SD, Maltenfort M, Albert TJ, Hilibrand AS, Vaccaro AR, Radcliff KE (2013) Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine 38(26):2253–2257. CrossRefPubMedGoogle Scholar
  28. 28.
    Zhu Y, Zhang B, Liu H, Wu Y, Zhu Q (2016) Cervical disc arthroplasty versus anterior cervical discectomy and fusion for incidence of symptomatic adjacent segment disease: a meta-analysis of prospective randomized controlled trials. Spine. PubMedCentralGoogle Scholar
  29. 29.
    Shriver MF, Lubelski D, Sharma AM, Steinmetz MP, Benzel EC, Mroz TE (2016) Adjacent segment degeneration and disease following cervical arthroplasty: a systematic review and meta-analysis. The Spine J 16(2):168–181. CrossRefPubMedGoogle Scholar
  30. 30.
    Ma Z, Ma X, Yang H, Guan X, Li X (2017) Anterior cervical discectomy and fusion versus cervical arthroplasty for the management of cervical spondylosis: a meta-analysis. Eur Spine J 26(4):998–1008. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryWashington University School of MedicineSaint LouisUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA
  3. 3.Department of Orthopedic SurgeryUniversity of CaliforniaLos AngelesUSA

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