Cervical Disc Replacement Does Not Increase Revision or Reoperation Risk Compared With Fusion in Osteoporotic Women: A Retrospective Matched Cohort Study
Kikelola Afolabi-Brown, Harshit Polavarapu, Joyce En-Hua Wang, Nicholas Cormas, Wendy Novicoff, Stephen Lockey, Xudong Joshua LiStudy Design
Retrospective Cohort Study.
Objectives
Cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) are both safe and effective surgical options for cervical spine pathologies such as myelopathy and radiculopathy. Comparative outcomes data for CDA versus ACDF in osteoporotic female patients remain limited despite this population’s increased vulnerability to postoperative complications. This study compares postoperative outcomes and healthcare utilization between single-level ACDF and CDA in this patient group.
Methods
Adult female patients aged ≥55 years with osteoporosis who underwent single-level CDA or ACDF between 2010 and 2022 were identified using the PearlDiver national database. A one-year washout period for prior cervical surgeries was applied, and patients receiving both procedures simultaneously were excluded. Eligible patients were matched three-to-one on age, Elixhauser Comorbidity Index (ECI), and smoking history. Outcomes included 90-day medical and surgical complications and 30-day, 90-day, and 2-year healthcare utilization metrics. Welch’s t-tests and Pearson χ2 tests were used for all comparisons. Statistical significance was set at
Results
678 female patients with osteoporosis underwent CDA (n = 170) or ACDF (n = 508). No baseline comorbidities differed significantly between groups. Incidences of 90-day medical and surgical complications and all healthcare utilization metrics were comparable between groups.
Conclusions
Our findings suggest CDA can be performed safely in female patients with an administrative diagnosis of osteoporosis, warranting further investigation with stratified bone-density–specific analyses.