Introduction: After anterior cervical discectomy, a fusion (ACDF) is generally performed. Artificial disc replacement (ADR) is gaining popularity. There is little Canadian evidence available regarding the benefits of one treatment over the other. Our objective was to determine if outcomes of ADR differed compared to ACDF.
Methods: We conducted a retrospective multivariate analysis of prospectively collected national Canadian Spine Outcomes and Research Network (CSORN) database. Multivariate logistic regression was used to adjust for possible confounding effects of age, gender, diagnosis, baseline function, and American Society of Anesthesiologists (ASA) score.
Results: There were 515 eligible patients: 39 had ADR in one or more spinal levels, and 476 had ACDF. At baseline, the ADR group was significantly younger, had lower ASA grades, and there trended to be more females. There was also a significantly higher proportion of neck pain and a lower proportion of myelopathy in the ADR group. Both ADR and ACDF patients had a similar number of levels operated on and there were no significant between-group differences at baseline in the percentage of smokers, neck and arm pain scores, overall health score, physical function and mental health scores. No significant differences were identified in surgery time, length of stay or improvements in PCS or MCS scores. At 12 months follow-up, overall improvement in EuroQol visual analogue scale (0-100) for ADR patients was significantly higher (mean 21.7 vs. 13.7, p=0.0383), but this difference did not maintain statistical significance in multivariate adjusted analysis. There was also a trend towards lower perioperative adverse events in the ADR group (2.6% vs. 10.1%, p=0.1233).
Conclusions: This is the first Canadian multicenter study to compare outcomes between ADR and ACDF. Although overall improvement in health-related quality of life favoured arthroplasty, we were unable to demonstrate this finding following adjusted analysis with our current study numbers.
Patient Care: Overall improvement in health-related quality of life favoured arthroplasty.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the differences in outcomes between ADR and ACDF