375 Cervical Arthroplasty in the Treatment of Myelopathy: Clinical Predictors, Utilization, and Outcomes in a Large Administrative Database

Abstract

INTRODUCTION: Cervical arthroplasty is a treatment for cervical radiculopathy; however, it may also be safe and effective in patients with mild myelopathy. METHODS: Retrospective data spanning 2016-2020 from the PearlDiver Patient Claims Database was used to select patients. Age, gender, osteoporosis, obesity, smoking, diabetes, Charlson Comorbidity Index (CCI), and 1- or 2-level surgery, re-operation rates, 90-day readmission, medical complications, and morphine milligram equivalents (MME) before/after surgery were collected. Univariate & multivariate analyses were performed to identify differences. Reoperation rates were compared using propensity-matched analysis. RESULTS: We identified n = 2,391 (4.5%) CDA and n = 50,845 ACDF procedures for cervical myelopathy. Predictors favoring CDA included female sex, younger age, lower CCI score, lower incidence of obesity, osteoporosis, diabetes, or smoking (p ≤ 0.001); remaining significant after multivariate analysis except sex (p = 0.06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and 2-level surgery, remaining significant after multivariable logistic regression except for diabetes (p = 0.23) and CCI (p = 0.05). The robustness of these factors were evaluated by matching patients (n = 2,391) with no difference in re-operation rates identified (p = 0.47). CONCLUSIONS: CDA patients are generally healthier (lower incidence of obesity, smoking, diabetes, CCI) and represents 4.5% of procedures for 1- or 2-level cervical myelopathy. Readmission rates, medical complications, and opiate use was lower with patients undergoing CDA, despite an overall similar reoperation rate. This study is limited by its retrospective nature and the lack of granular outcomes measurements. However, the data suggests that CDA is a viable option for cervical myelopathy.