Study Design. Retrospective cohort. Objective. To evaluate differences, if any, in patient selection, patient-reported outcomes, and complication profiles between anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). Summary of Background Data. ACDF has long been the standard for cervical degenerative disc disease (DDD), but concerns about adjacent segment disease (ASD) have driven interest in CDA as a motion-preserving alternative. We hypothesize that there will be differences in patient demographics, but not outcomes, for those undergoing ACDF and CDA for cervical DDD. Methods. A retrospective review was conducted of patients undergoing single-level ACDF or CDA at a single academic institution between 2014 and 2024. Demographics, surgical characteristics, patient-reported outcomes, and complications were extracted from electronic medical records. Primary outcomes included postoperative hematoma, 30-day readmissions, ASD noted by radiology reads or in orthopedic spine clinic notes, and reoperations. Results. Data from 337 patients (207 ACDF, 130 CDA) was analyzed. Compared to ACDF patients, CDA patients were younger (44.44 vs. 54.43 y, P <0.001), had lower osteoporosis rates (1.54% vs. 11.11%, P <0.001), and were most frequently ASA Class II (67.69% vs. 50.24%, P <0.001). Patient-reported outcomes generally did not differ across procedure types. Revision at the index level was more common in CDA (5.38% vs. 0.48%, P =0.006), whereas extension to an adjacent level was more common in ACDF (9.66% vs. 2.31%, P =0.008). Regression analyses controlling for age, BMI, osteoporosis, and surgical levels confirmed CDA as a unique predictor of increased revision risk (OR 12.48, P =0.042), and ACDF as a unique predictor of increased ASD risk (OR 0.11, P <0.001). Conclusions. ACDF and CDA are safe and effective for single-level cervical DDD. CDA was associated with lower readmissions and reduced adjacent pathology, but higher index-level revision risk. These findings support CDA as a motion-preserving alternative to ACDF in appropriately selected patients. Level of Evidence. III.
Friedman et al. (Fri,) studied this question.