Ten-Year Risk of Revision and Complications Following Cervical Spine Surgery in HIV-Positive Patients: A Large Propensity-Matched US Cohort (2010–2023)

Study Design: Retrospective cohort. Objective: To compare short-term complications and long-term revision risk after cervical spine surgery between patients with or without human immunodeficiency virus (HIV). Summary of Background Data: Prior work in thoracolumbar cohorts suggests comparable outcomes between patients with versus without HIV. These similarities are attributed to modern care, but outcomes in cervical spine surgery studies remain unexplored. Materials and Methods: Using the PearlDiver Mariner170 database (2010–2023), adults undergoing primary cervical spine surgery were identified by CPT/ICD codes. HIV-negative controls were matched 2:1 to HIV-positive patients on age range, sex, and Charlson Comorbidity Index. Short-term outcomes were 30- and 90-day medical and surgical complications; long-term outcomes were 10-year revisions for infection, pseudoarthrosis, mechanical failure, and adjacent segment disease. Group differences used the χ 2 /Welch t tests; 10-year risks used Cox models [hazard ratios (HR), 95% CI]. Results: The matched cohort comprised 4021 HIV-positive patients and 8037 controls with balanced baseline characteristics. At 30 days, HIV-positive patients had lower rates of acute kidney injury (2.8% vs. 3.7%, P =0.014), renal disease (5.9% vs. 8.8%, P <0.001), stroke (1.2% vs. 2.0%, P =0.003), bladder dysfunction (1.6% vs. 2.7%, P <0.001), and rebleeding (3.5% vs. 4.5%, P =0.009). At 90 days, the HIV group had decreased rates of the following: acute kidney injury, renal disease, stroke, pulmonary embolism, bladder dysfunction, and rebleeding (all P <0.05). Over 10 years, there were no significant differences in all-cause revision (HR: 0.99, P =0.963) or revisions for pseudoarthrosis (0.89, P =0.673), mechanical failure (0.96, P =0.885), or adjacent segment disease (0.79, P =0.654). Conclusions: In a large matched cohort, HIV-positive status was not associated with increased short-term complications or long-term revision risk after cervical spine surgery; several short-term complications were less frequent among HIV-positive patients. When medically optimized and appropriately selected, HIV-positive patients should not be excluded from elective cervical spine procedures based on HIV status alone.