Attending Surgeon Norton Leatherman Spine Center Princeton University Louisville, KY, US
Disclosure(s):
Charles H. Crawford, MD, III: No relevant disclosure to display
Introduction: Durability of surgical treatment is important to patients, providers, and payors. In addition to the effect on outcomes and satisfaction, durability is important when evaluating cost-effectiveness. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure. The purpose of this study was to analyze the prevalence and indications for reoperation following ACDF.
Methods: A multi-surgeon, single-institution database was queried for reoperation following ACDF (CPT=22551) from 2014 to 2018 with a minimum follow-up of four years (N=1652). The mean patient age was 53.6 years, number of surgical levels was 1.8, BMI was 30.5 kg/m2, ASA was 2.6, length of stay was 1.4 days, and OR time was 154.3 minutes
Results: A total of 147/1652 patients (9%) underwent unplanned reoperation during the study period. The most common indication for reoperation was non-union (N=94, 6%) which occurred at a mean of 33 months postop. The second most common indication was adjacent segment disease (N=37, 2%) which occurred at a mean of 24 months postop. Patients who had a reoperation for nonunion had more levels fused (2.06) compared to patients who had no reoperation (1.65) or had surgery for adjacent segment disease (1.76) (p < 0.006). No other differences were found among these groups. Other indications for reoperation 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).
Conclusion : The results of the current study show that ACDF is a relatively durable procedure (91%) as currently indicated and performed in a large multi-surgeon spine center. Early reoperation ( < 90 days) for hematoma or infection is rare. Late reoperation (>90 days) for non-union is more than twice as common as adjacent segment disease and occurred earlier and more commonly when a greater number of levels were fused.
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