Thursday, September 27, 2018 3:35 PM–5:05 PM Section on Motion Technology Abstract Presentations: 132. Subsequent cervical spine surgery after cervical disc arthroplasty and anterior cervical discectomy and fusion.

BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) has emerged as an alternative surgical option to anterior cervical discectomy and fusion (ACDF) for cervical disc pathology, with recent trials demonstrating non-inferiority of CDA to ACDF. While short-term trends regarding utilization rates, revision procedures and complications have been explored, longer-term outcomes, specifically involving re-operation rates and type of reoperation are lacking. Therefore, we used the New York Statewide Planning and Research Cooperative Systems (SPARCS) database to characterize subsequent cervical spine surgery in patients undergoing primary elective CDA and ACDF. PURPOSE Characterize subsequent cervical spine surgery in patients undergoing primary elective CDA and ACDF. STUDY DESIGN/SETTING Retrospective state database study. PATIENT SAMPLE Patients who underwent elective inpatient CDA and ACDF in New York State. METHODS We analyzed the SPARCS inpatient database from 2005 to 2013 to identify patients who underwent elective inpatient CDA and ACDF procedures. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to extract the index procedures (CDA: 84.61, 84.62; ACDF: 81.02) and to identify patient demographics and cervical re-operation procedures. Patients were longitudinally followed until September 2015, corresponding to a minimum of two year follow-up, to determine the incidence of subsequent cervical spine reoperation, which included another primary CDA or ACDF, revision CDA or ACDF, and posterior cervical fusion. Logistic regression analysis was used to determine the odds of subsequent cervical spine reoperation. RESULTS Between January 2005 and September 2013, 731 patients underwent an inpatient CDA and 45,204 underwent an inpatient ACDF. Patients undergoing CDA were more likely to be younger (43.6 vs. 50.7, p<.0001), to have fewer comorbidities (p<.001), and to have a cervical diagnosis of disc displacement (68.4% vs. 46.5%, p<.001). Subsequent cervical spine reoperation rates did not differ at one (OR=1.06, 95%CI=0.60–1.89, p=.840) or two years (OR=1.35, 95%CI=0.95–1.94, p=.099) postoperatively. When analyzing subsequent cervical reoperations, CDA patients were 29 times more likely to return to the operating room to receive a primary ACDF procedure compared to ACDF patients returning to undergo a primary CDA procedure (OR=29.13, 95%CI: 19.52–43.48, p<.001). Patients undergoing CDA had a decreased odds of undergoing another CDA primary procedure at adjacent cervical levels compared to ACDF patients undergoing another primary cervical ACDF procedure (OR:0.17, 95%CI:0.07–0.46, p<.001). Patients undergoing CDA had a decreased odds of undergoing revision CDA compared to ACDF patients undergoing revision ACDF (OR:0.41, 95%CI:0.17–0.98, p=.045). The most common reason for subsequent cervical re-operation after CDA or ACDF was cervical disc displacement (CDA: 28.6%, ACDF: 21.4%). CONCLUSIONS Compared to patients undergoing ACDF, patients undergoing CDA are more likely to be younger, to have fewer comorbidities and to have a primary diagnosis of cervical disc displacement. While there is no significant difference in subsequent cervical spine re-operation rates between ACDF and CDA, surgeons performing revision procedures at the same cervical level or performing primary procedures at adjacent cervical levels are more likely to utilize ACDF rather than CDA. Further investigation in outpatient primary and revision cervical spine cases is needed to assess these findings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

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