Anterior cervical corpectomy and fusion with stand-alone cages in patients with multilevel degenerative cervical spine disease is safe

Background In case of spinal cord compression behind the vertebral body, anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies. The objective of the study is to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by stand-alone cages for anterior cervical corpectomy and fusion (ACCF). Methods Thirty-one patients (66.5 ± 9.75 years, range 53–85 years) were analyzed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after one year at least. Assessment of radiographic fusion, subsidence, and lordosis measurement of Global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height (ant. DSH); the posterior interbody space height (post. DSH); the distance of the cage to the posterior wall of the vertebral body (CD) were done retrospectively. Mean clinical and radiographic follow-up was 20.0 ± 4.39 months. Results VAS-neck (p = 0.001) and VAS-arm (p < 0.001) improved from preoperatively to postoperatively. The NDI improved at the final follow-up (p < 0.001). Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. All patients showed a radiographic union of the surgically addressed segments at the last follow up. Conclusions Application of a stand-alone expandable cage in the cervical spine after one or two-level ACCF without additional posterior fixation or anterior plating is a safe procedure that results in fusion. Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. Trial registration Retrospectively registered. According to the Decision of the ethics committee, Jena on 25th of July 2018, that this study doesn’t need any registration. https://www.laek-thueringen.de/aerzte/ethikkommission/registrierung/.

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

BACKGROUND Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously. OBJECTIVE To analyze the occurrence, risk factors, and trends in reoperations in a long-term follow-up of all the patients operated for degenerative cervical spine disease in Finland between 1999 and 2015. METHODS The patients were retrospectively identified from the Hospital Discharge Registry. Reoperations were traced individually; only reoperations occurring &gt;365 d after the primary operation were included. Time trends in reoperations and the risk factors were analyzed by regression analysis. RESULTS Of the 19 377 identified patients, 9.2% underwent a late reoperation at a median of 3.6 yr after the primary operation. The annual risk of reoperation was 2.4% at 2 yr, 6.6% at 5 yr, 11.1% at 10 yr, and 14.2% at 15 yr. Seventy-five percent of the late reoperations occurred within 6.5 yr of the primary operation. Foraminal stenosis, the anterior cervical decompression and fusion (ACDF) technique, male gender, weak opiate use, and young age were the most important risk factors for reoperation. There was no increase in the risk of reoperations over the follow-up period. CONCLUSION The risk of reoperation was stable between 1999 and 2015. The reoperation risk was highest during the first 6 postoperative years and then declined. Patients with foraminal stenosis had the highest risk of reoperation, especially when ACDF was performed.

Variation in 90-Day Postoperative Costs Among Patients Undergoing Elective Anterior Cervical Discectomy and Fusion: Insights From the OPTUM Labs Data Warehouse (OLDW)

INTRODUCTION Anterior Cervical Discectomy and Fusion (ACDF) has been shown to be associated with high direct and associated costs. We aimed to identify factors associated with higher 90-day costs following elective ACDF for degenerative cervical spine disease among patients with commercial insurance and those on Medicare Advantage, using an administrative database. METHODS Optum Labs Data Warehouse (OLDH) was queried for patients undergoing an anterior cervical decompression and fusion (ACDF) for degenerative cervical spine disease. between 2012 and 2015. Geographic variations were evaluated as per U.S. Census Division. Patients were stratified by insurance status (commercial or Medicare advantage) and by the 9 US census regions. The primary outcome was all postoperative 90-d costs. RESULTS A total of 29 380 patients underwent an ACDF of which 86.7% patients had commercial insurance while 13.3% had Medicare Advantage. Regional 90-d adjusted mean costs per patient varied significantly between the 2 insurance groups, most notably for patients with commercial insurance undergoing ACDF ($70,765.17 for Mid-Atlantic to $29,364.02 for East South Central). Multivariable regression analyses revealed that the geographic region where procedure was performed, number of operated levels, number of readmissions and number of ED visits were significantly associated with higher costs. CONCLUSION There is significant regional variation in 90-d postoperative adjusted costs for patients on commercial and Medicare insurance undergoing elective ACDF. These analyses are important to help surgeons develop region-specific interventions to alleviate the cost burden for patients and assist policymakers in designing better risk-adjusted reimbursement policies for providers and hospitals.