Comparison Between Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion of 1 to 2 Levels From 2002 to 2009
Study Design. Retrospective database analysisObjective. To compare the perioperative patient characteristics, early postoperative outcomes, and costs between an anterior cervical discectomy and fusion versus a cervical total disc replacement surgery in the United States.Summary of Background Data. Cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) are indicated to treat symptomatic cervical degenerative pathology. The epidemiology, complication rates, and the cost differences between the two surgical approaches are not well characterized.Methods. Data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project was queried from 2002-2009. Patients undergoing a cervical TDR or 1-2 level ACDF were identified. Patient demographics, comorbidities, length of stay (LOS), costs, and the in-hospital complications were assessed. SPSS v.20 was utilized for statistical analysis with χ test for categorical data and Independent-Samples T test for continuous data. A p-value of ≤0.001 denoted statistical significance. Multinomial regression analysis was utilized to identify the independent risk for complications in the TDR cohort compared to the ACDF cohort.Results. There were 141,230 1-2 level ACDFs and 1,830 cervical TDRs identified in the NIS database. The ACDF cohort was older and demonstrated a greater comorbidity burden compared to the TDR group (p<0.001). The ACDF treated patients demonstrated a significantly greater LOS than the TDR group (p<0.001). In contrast, there were no significant differences in incidences of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques.Conclusion. The ACDF cohort was significantly older and demonstrated a greater comorbidity burden which likely contributed to the greater length of stay (LOS) when compared to the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications and costs. There were no significant differences in the risks for postoperative complications between the surgical cohorts. Further studies are warranted to characterize the long term complications, costs, and patient outcomes between the two surgical techniques.
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