Revision Surgery after Single Level Anterior Cervical Discectomy and Fusion With Plate vs Stand-Alone Cage over 2 to 5 Year Follow-Up

Study Design: retrospective study. Objective: To investigate the incidence of all-cause revision surgery between plated vs stand-alone cage constructs for single level ACDF. Methods: We retrospectively analyzed a commercial insurance claims database. Patients 18–65 years-old were included if they underwent single-level inpatient ACDF (defined with CPT codes) from 2010 – 2018, with a minimum of 2-year continuous insurance enrollment. The primary independent variable was the use of anterior plating vs zero profile device or stand-alone cage. Synthetic (ie, metal, PEEK, etc.) vs allograft interbody was a secondary independent variable. The primary outcome variable was revision cervical arthrodesis after the index operation. Results: In total, 21092 patients undergoing single-level inpatient ACDF were included. 10.0% received a stand-alone cage during the index operation. Mean follow-up duration was 4.5 years. Revision arthrodesis occurred in 8.2% of patients overall, at a mean of 2.4 years after the index surgery. Patients with anterior plating had a lower rate of all-cause revision surgery in unadjusted (overall rate 8.1% vs 9.6%, P = 0.0185) and adjusted analysis (OR 0.78, P = 0.0016) vs stand-alone cages. Patients with stand-alone cages had higher rates of revision with a posterior approach than did patients with plated constructs. In sub-analysis, the combination of a stand-alone interbody device with an allograft had significantly higher odds of revision than other combinations of devices. Conclusion: Among commercially insured patients ≤65 years-old undergoing single-level ACDF, anterior plating was associated with a reduced incidence of revision surgery compared to stand-alone cages within the follow up period of our study.