Introduction: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common treatments for cervical radiculopathy and myelopathy. While ACDF remains the gold standard, CDA is gaining popularity due to the benefit of motion preservation. However, national trends in outcomes between these procedures remain unclear.
Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients aged >18 who underwent ACDF or CDA between 2012 and 2022, using CPT codes 22551 and 22856. Annual rates of demographics, comorbidities, and 30-day complications were analyzed. Univariate analysis evaluated outcomes including readmission, reoperation, and length of stay (LOS).
Results: We identified 93,989 ACDF and 8708 CDA patients. From 2012 to 2022, the proportion of ACDF cases declined from 96.3% to 90.2%, while CDA cases increased from 3.7% to 9.9%. ACDF patients were older (55.7 vs. 46.8 years) and had higher body mass index (30.6 vs. 29.6) (P < 0.001). Diabetes increased in both cohorts (ACDF: 15.3%-20.7%; CDA: 5.9%-11.3%), as did hypertension (ACDF: +8.7%; CDA: +5.4%) (P < 0.001). Steroid use (+2.2%, P < 0.001) and chronic obstructive pulmonary disease (+1.0%, P = 0.021) rose in ACDF only. LOS decreased in ACDF (1.94-1.76 days, P < 0.001) but rose in CDA (1.10-1.15 days, P = 0.023). Readmissions increased in both (ACDF: 2.9%-3.25%; CDA: 0.74%-1.01%, P < 0.001).
Conclusion: CDA continues to show favorable short-term outcomes compared to ACDF but remains less utilized overall. These trends may guide surgical planning and patient counseling in cervical spine care.
Keywords: American college of surgeons national surgical quality improvement program; anterior cervical discectomy; cervical disc arthroplasty; fusion; postoperative complications; trends.
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