Reoperation rate after anterior cervical discectomy and fusion using standalone cages in degenerative disease: a study of 2,078 cases

Abstract

BACKGROUND CONTEXTOver the last two decades, there has been a rapid increase in the use of cervical spine interbody fusion cages. Reoperation rate remains an important determinant of procedural efficacy and safety. PURPOSETo evaluate the rate and reasons for reoperations in cervical spondylosis patients undergoing anterior decompression and fusion using stand-alone cervical interbody fusion cages. STUDY DESIGNA retrospective study of 2,078 consecutive cases of degenerative cervical spine disease undergoing fusion using stand-alone cages. PATIENT SAMPLEBetween January 2005 and December 2014, 2,078 patients underwent anterior cervical decompression and fusion using stand-alone cages in our institution. OUTCOME MEASURESThe reoperations were analyzed and classified into early (during the first 90 days postoperatively) and late (after 90 days) reoperations. The rate and the causes of reoperation in both groups were reported and the results were compared. METHODSIn 1,558 patients, a short segment fusion (≤2 levels) was performed, while the remaining 520 patients underwent a long segment fusion (≥3 levels). RESULTSThe overall incidence of reoperation was 5.63%. The rate of early reoperations was 2.07%, mostly due to postoperative hematoma, and the rate of late reoperations was 3.56%, mostly due to adjacent segment disease. Revision due to pseudarthrosis was performed in 0.58% of cases. The early reoperation rate was significantly higher in the group with a long segment fusion, while the late reoperation rate was significantly higher in patients undergoing a short segment fusion. CONCLUSIONFollowing anterior cervical decompression and fusion with a stand-alone cage, the overall incidence of symptomatic pseudarthrosis is low. Patients undergoing long segment fusion should be closely observed in the early postoperative period as they have a higher early complication rate. On the other hand, long segment fusions have a lower incidence of adjacent segment disease over the years.