Comparison of Characteristics, Inpatient Outcomes, and Current Trends in Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion: A US Nationwide Cohort Analysis
Medical Student/Clinical Neuroscience Research Fellow New York Medical College & Westchester Medical Center Valhalla, NY, US
Introduction: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical spine radiculopathy, while cervical disc arthroplasty (CDA) has emerged as a popular alternative due to its motion-preserving benefits. However, recent population-level comparisons of these two procedures remain limited. This study examines the demographics, utilization patterns, and inpatient outcomes of CDA versus ACDF.
Methods: The Nationwide Inpatient Sample (NIS) database (2016-2021) was used to identify cervical radiculopathy cases treated with either ACDF or CDA through ICD-10 codes. Data on demographics, complications, length of stay (LOS), hospital characteristics, and annual trends were collected. Inpatient outcomes were analyzed with multivariate logistic regression, adjusted for age, gender, and comorbidities.
Results: Among 104,255 patients, 86.8% underwent ACDF and 13.2% CDA. CDA patients were younger (mean 47.2 vs. 54.15 years; P< 0.001) with fewer comorbidities (Elixhauser Index 1.1064 vs. 1.5855; P< 0.001) and were more likely to have private insurance (63.9% vs. 47.3%; OR=1.975, P< 0.001). Medicaid and Medicare were more common among ACDF patients. CDA was linked to fewer complications of aspiration pneumonitis (OR=0.238) and acute kidney injury (OR=0.508), a shorter LOS (1.34 vs. 1.52 days), and higher hospital charges ($90,210 vs. $67,504), with a greater likelihood of routine discharge (93.8% vs. 91%; all P< 0.001). Yearly trends showed increased CDA utilization, with odds ratios rising from 0.67 in 2016 to 1.558 in 2021 (P < 0.001). CDA was more common in large hospitals (OR=1.051) and the West (OR=2.363), while ACDF was more frequent in rural settings (OR=1.465, P< 0.001) and the South (OR=1.72; all P< 0.05).
Conclusion : CDA patients tend to be younger, healthier, and experience fewer complications, with shorter LOS, higher costs, and more routine discharges than ACDF patients, who often have a higher comorbid burden. These findings suggest CDA may be preferable for a younger, healthier population, while ACDF patients may require more extensive postoperative care. Yearly trends indicate rising utilization for CDA, particularly in large hospitals and in the Western United States, whereas ACDF remains more common in rural areas and the South. Further research is needed to explore the roles of insurance type and socioeconomic factors in cervical spine surgery choices and outcomes.