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Study Design <p>Retrospective Cohort Study.</p> Purpose <p>To compare 30-day postoperative outcomes of cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF) in single-level cervical degenerative disc disease (CDDD) using a frailty-based propensity score matched model. Frailty, quantified using the Risk Analysis Index (RAI), was treated as both a confounding variable for matching and as an independent predictor of postoperative outcomes, allowing assessment of its predictive value and potential role as an effect modifier in evaluating surgical outcomes following CDR.</p> Methods <p>The ACS-NSQIP database (2012-2022) was queried for adults undergoing single-level ACDF or CDR for CDDD. Patients with fractures, tumors, emergent cases, or incomplete data were excluded. Outcomes included 30-day mortality, major and minor complications, Clavien-Dindo IV complications, non-home discharge (NHD), readmission, reoperation, and extended length of stay. Propensity score matching was performed controlling for frailty as quantified by the RAI. Multivariate logistic regression and receiver operating characteristic curves assessed associations and predictive accuracy.</p> Results <p>Among 97,408 patients (8.7% CDR), CDR patients were younger and less frail. After matching 16,974 patients, CDR was associated with significantly lower odds of major complications (OR 0.57), NHD (OR 0.60), readmission (OR 0.60), and reoperation (OR 0.61) compared to ACDF, with no mortality difference. Each 1-point increase in RAI corresponded to higher odds of mortality (+24%), major complications (+11%), and NHD (+17%). RAI demonstrated strong discrimination for mortality (C=0.85) and NHD (C=0.76).</p> Conclusions <p>CDR is associated with fewer short-term adverse outcomes than ACDF, even in frail patients. Frailty strongly predicts postoperative risk but does not diminish the relative safety of CDR. The RAI is a valuable preoperative risk stratification tool for cervical spine surgery.</p>

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ACDF and cervical disc replacement for single-level cervical spine degenerative disease: a frailty driven propensity score-matched comparative analysis

  • 期刊论文

  • 发表日期：

    2026年2月4日

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  • Nithin Gupta,
  • Omar Sbaih,
  • William DiCiurcio III,
  • Mark Miller,
  • Ruchir Nanavati,
  • Hunter Smith,
  • Blake Delgadillo,
  • Matthew Meade,
  • Aman Singh,
  • Rohin Singh,
  • Christian Bowers

摘要

Study Design

Retrospective Cohort Study.

Purpose

To compare 30-day postoperative outcomes of cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF) in single-level cervical degenerative disc disease (CDDD) using a frailty-based propensity score matched model. Frailty, quantified using the Risk Analysis Index (RAI), was treated as both a confounding variable for matching and as an independent predictor of postoperative outcomes, allowing assessment of its predictive value and potential role as an effect modifier in evaluating surgical outcomes following CDR.

Methods

The ACS-NSQIP database (2012-2022) was queried for adults undergoing single-level ACDF or CDR for CDDD. Patients with fractures, tumors, emergent cases, or incomplete data were excluded. Outcomes included 30-day mortality, major and minor complications, Clavien-Dindo IV complications, non-home discharge (NHD), readmission, reoperation, and extended length of stay. Propensity score matching was performed controlling for frailty as quantified by the RAI. Multivariate logistic regression and receiver operating characteristic curves assessed associations and predictive accuracy.

Results

Among 97,408 patients (8.7% CDR), CDR patients were younger and less frail. After matching 16,974 patients, CDR was associated with significantly lower odds of major complications (OR 0.57), NHD (OR 0.60), readmission (OR 0.60), and reoperation (OR 0.61) compared to ACDF, with no mortality difference. Each 1-point increase in RAI corresponded to higher odds of mortality (+24%), major complications (+11%), and NHD (+17%). RAI demonstrated strong discrimination for mortality (C=0.85) and NHD (C=0.76).

Conclusions

CDR is associated with fewer short-term adverse outcomes than ACDF, even in frail patients. Frailty strongly predicts postoperative risk but does not diminish the relative safety of CDR. The RAI is a valuable preoperative risk stratification tool for cervical spine surgery.