Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study
Location
LSUHSC Center for Advanced Learning and Simulation (CALS)
Document Type
Presentation
Start Date
22-6-2024 10:30 AM
End Date
22-6-2024 11:25 AM
Publication Date
2024-06-22
Description
Introduction: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy associated with complications including postoperative dysphagia. Previous research has suggested a relationship between complications and level involvement, however there is limited direct compairson of post-operative outcomes in upper cervical spine fusions (UCF) versus middle to lower cervical spine fusions (MLCF). This study aims to compare the overall outcomes of UCF (defined as fusions involving C3-C4 disc space) with MLCF (defined as the remainder of the cervical spine). Due to the more complex anatomy and indirect data suggesting increased rates of dysphagia after UCF, the authors hypothesized increased rates of complications following UCF compared to MLCF. METHODS: A retrospective chart review of 835 patients who underwent ACDF from 2012 to 2022 was conducted with patients classified as either upper cervical fusion (UCF), defined as inclusion of C3-4 disc-space, or middle-lower cervical fusion (MLCF), defined as lacking C3-4 disc-space. Demographic characteristics were compared using either χ2 tests or Fisher exact tests. Clinical characteristics were compared in univariable analysis using either χ2 tests, linear-mixed effects models, or generalized linear-mixed models depending on their distribution. Characteristics including demographics, number of levels fused, spinal cord signal change, and neurological diagnosis were included in the multivariable models to minimize confounding. Results: A total of 835 patients were included in the current analysis, comprising 562 in the MLCF group and 281 in the UCF group. The median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay (LOS) compared to MLCF in both univariable (1.5 vs. 3.1, p<0.0001) and multivariable analysis [2.3 days (95% CI: 1.8, 3.0) vs. 3.3 days (2.6, 4.2), p<0.0001]. MLCF patients reported improvement or resolution in their symptoms more often than UCF patients [0.43 (95% CI: 0.30, 0.62) and 0.46 (95% CI: 0.30, 0.70)]. There was no significant difference observed in rates of major complications or revision surgeries. However, there was a significantly higher rate of minor complications, specifically dysphagia, in the UCF group both on univariate and multivariable analysis, respectively [1.72 (95% CI: 1.18, 2.49) and 1.66 (95%CI: 1.08, 2.56),]. Discussion: To our knowledge this study is the first to directly investigate the link between cervical fusion level and post-operative outcomes. UCF patients had increased rates of post-operative dysphagia, longer LOS, and were less likely to report an improvement in neurological symptoms post-operatively when compared to MLCF patients both before and after controlling for demographic differences, number of levels fused, presence of spinal cord signal change on pre-operative radiographs, and type of neurological symptoms. Future prospective studies are needed to confirm these findings. Significance/Clinical relevance: UCF may be associated with increased likelihood of post-operative dysphagia, longer LOS, increased likelihood of non-home discharge from hospital and a lower likelihood of improvement in neurological symptoms compared to MLCF.
Recommended Citation
Schroeder, Ryan, "Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study" (2024). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 12.
https://digitalscholar.lsuhsc.edu/ortho_rd/2024/presentation2/12
Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study
LSUHSC Center for Advanced Learning and Simulation (CALS)
Introduction: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy associated with complications including postoperative dysphagia. Previous research has suggested a relationship between complications and level involvement, however there is limited direct compairson of post-operative outcomes in upper cervical spine fusions (UCF) versus middle to lower cervical spine fusions (MLCF). This study aims to compare the overall outcomes of UCF (defined as fusions involving C3-C4 disc space) with MLCF (defined as the remainder of the cervical spine). Due to the more complex anatomy and indirect data suggesting increased rates of dysphagia after UCF, the authors hypothesized increased rates of complications following UCF compared to MLCF. METHODS: A retrospective chart review of 835 patients who underwent ACDF from 2012 to 2022 was conducted with patients classified as either upper cervical fusion (UCF), defined as inclusion of C3-4 disc-space, or middle-lower cervical fusion (MLCF), defined as lacking C3-4 disc-space. Demographic characteristics were compared using either χ2 tests or Fisher exact tests. Clinical characteristics were compared in univariable analysis using either χ2 tests, linear-mixed effects models, or generalized linear-mixed models depending on their distribution. Characteristics including demographics, number of levels fused, spinal cord signal change, and neurological diagnosis were included in the multivariable models to minimize confounding. Results: A total of 835 patients were included in the current analysis, comprising 562 in the MLCF group and 281 in the UCF group. The median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay (LOS) compared to MLCF in both univariable (1.5 vs. 3.1, p<0.0001) and multivariable analysis [2.3 days (95% CI: 1.8, 3.0) vs. 3.3 days (2.6, 4.2), p<0.0001]. MLCF patients reported improvement or resolution in their symptoms more often than UCF patients [0.43 (95% CI: 0.30, 0.62) and 0.46 (95% CI: 0.30, 0.70)]. There was no significant difference observed in rates of major complications or revision surgeries. However, there was a significantly higher rate of minor complications, specifically dysphagia, in the UCF group both on univariate and multivariable analysis, respectively [1.72 (95% CI: 1.18, 2.49) and 1.66 (95%CI: 1.08, 2.56),]. Discussion: To our knowledge this study is the first to directly investigate the link between cervical fusion level and post-operative outcomes. UCF patients had increased rates of post-operative dysphagia, longer LOS, and were less likely to report an improvement in neurological symptoms post-operatively when compared to MLCF patients both before and after controlling for demographic differences, number of levels fused, presence of spinal cord signal change on pre-operative radiographs, and type of neurological symptoms. Future prospective studies are needed to confirm these findings. Significance/Clinical relevance: UCF may be associated with increased likelihood of post-operative dysphagia, longer LOS, increased likelihood of non-home discharge from hospital and a lower likelihood of improvement in neurological symptoms compared to MLCF.