Reoperation Rate Following Single-Level Anterior Cervical Discectomy and Fusion With Standalone Cage Versus Anterior Plating in a Large Matched Cohort

Study design: Retrospective study. Objective: To compare reoperation rates between single-level standalone anterior cervical discectomy and fusion (ACDF) and ACDF with anterior plating. Summary of Background Data: ACDF is a widely performed procedure for cervical degenerative disc disease and may utilize standalone cages or cages with anterior plating. Reoperation rate serves as a critical measure of long-term success and durability of each technique. Methods: The PearlDiver national insurance claims database was used to identify patients who underwent single-level ACDF with a standalone cage or ACDF with a plate. 1:1 matched cohorts were created based on age, sex, Elixhauser Comorbidity Index score, and year of surgery. The primary outcome was the reoperation rate at 2 years postoperatively. Secondary analyses included reoperation rate at 1-year and 5-years, reoperation stratified by surgical approach, and rate of epidural or facet injections at 2-years after index surgery. Statistical analyses included χ 2 tests and Kaplan-Meier analysis to compare reoperation rates. Results: Nine thousand three hundred twenty-six patients were included in each cohort after matching. The 2-year reoperation rate was 3.26% for ACDF with plate and 3.31% for standalone ACDF ( P =0.837). No significant difference was found in reoperation rates at 1-year, 2-year, and 5-year. Kaplan-Meier analysis additionally demonstrated no significant difference in reoperation-free survival over time. Patients undergoing standalone ACDF had higher rates of posterior approach reoperations within 2 years (1.22% vs. 0.84%, P =0.011). No significant differences were found in the rate of epidural or facet injections between groups. Conclusions: Standalone and plated single-level ACDF provide comparable long-term outcomes in terms of reoperation rates. This study is the largest matched cohort to date of patients who underwent single-level ACDF with and without anterior plating. Level of Evidence: Level III.