Most studies looking into revision rates after cervical spine fusion follow patients for 2 to 5 years. But in the September 21, 2016 issue of JBJS, Derman et al. investigate revision rates—and risk factors for revision—with a follow-up of 16 years.
Analyzing New York State’s SPARCS all-payer database, the authors identified more than 87,000 patients who underwent a primary subaxial cervical arthrodesis from 1997 through 2012. During the study period, 7.7% of the patients underwent revision, with a median time to revision of 24.5 months.
Cervical arthrodeses performed with anterior-only approaches had a significantly higher probability of revision than those performed via posterior or circumferential approaches. The authors also found that the following characteristics were associated with an elevated revision risk:
- Patient age of 18 to 34 years
- White race
- Workers’ Compensation or Medicare (but not Medicaid) coverage
- Arthrodeses to address spinal stenosis, spondylosis, deformity, or neoplasm
Shorter arthrodeses (i.e., fewer fusion levels) and arthrodesis to address fractures were associated with relatively lower revision risks.
The authors conclude that “knowledge of these factors should help to promote exploration of strategies to reduce the prevalence of revision(s)…and to facilitate more accurate preoperative counseling of patients.”