Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient

Majd Marrache; Rachel Brnheim; Andrew B. Harris; Varun Puvanesarajah; Micheal Rad; Sang Lee; Richard Skolasky; Amit Jain

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자료유형: 학술저널

저자정보: Majd Marrache (The Johns Hopkins University) Rachel Brnheim (The Johns Hopkins University) Andrew B. Harris (The Johns Hopkins University) Varun Puvanesarajah (The Johns Hopkins University) Micheal Rad (The Johns Hopkins University) Sang Lee (The Johns Hopkins University) Richard Skolasky (The Johns Hopkins University) Amit Jain (The Johns Hopkins University)

저널정보: 대한척추신경외과학회 Neurospine 대한척추신경외과학회지 제17권 제4호

발행연도: 2020.1

수록면: 896 - 901 (6page)

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Objective: The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology. Methods: We queried a private claims database to identify adult patients (≤65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p<0.05. Results: A total of 26,754 patients were included in the study. 11,514 patients (43%) underwent ACDF with structural allograft and 15,240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of all-cause reoperation compared to the allograft group (9.1% vs. 8.0%, p=0.002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23,475 vs. $20,836, p<0.001). Conclusion: Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.

#Anterior cervical discectomy and fusion #Radiculopathy #Reoperation #Hospital costs #Allografts #Synthetic cage

참고문헌 (23)

참고문헌 신청

Smith GW / 1958 / The treatment of certain cervicalspine disorders by anterior removal of the intervertebral disc and interbody fusion / J Bone Joint Surg Am 40-A:607~624

Oglesby M / 2013 / Epidemiological trends in cervical spine surgery for degenerative diseases between 2002 and 2009 / Spine 38:1226~1232

Salzmann SN / 2018 / Cervical spinal fusion : 16-year trends in epidemiology, indications, and inhospital outcomes by surgical approach / World Neurosurg 113:e280~e295

Goz V / 2019 / Complications and risk factors using structural allograft versus synthetic cage : analysis 17 783 anterior cervical discectomy and fusions using a national registry / Global Spine J 9:388~392

Yoon ST / 2017 / ACDF graft selection by surgeons : survey of AOSpine members / Global Spine J 7:410~416

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