Analysis of Causes and Risk Factors of Revision Surgery after Anterior Cervical Discectomy and Fusion for Lower Cervical Degenerative Diseases

Purpose: This study evaluated the causes and risk factors for revision surgery after anterior cervical discectomy and fusion (ACDF) for lower cervical degenerative diseases and verified the factors that can reduce the possibility of revision surgery.Materials and Methods: Six hundred and sixty-one patients who underwent ACDF by one of two board-certified orthopedic spine surgeons for lower cervical degenerative diseases between 2004 and 2021 were enrolled in this study.The patients were divided into two groups based on whether or not they had undergone revision surgery.The statistical significance was analyzed for the age, sex, height, weight, body mass index, status of diabetes mellitus, symptoms at presentation (radiculopathy, myelopathy, and myelo-radiculopathy), number of fusion level, graft type, and smoking status of patients in each group to assess the risk factors for revision surgery.For statistical analysis, a Fisher's exact test, t-test, and chi-square analysis were conducted according to variables.Results: Fifty-two out of 661 (7.9%) patients underwent revision surgery.The revision surgery took place at an average of 66.3 months after ACDF.The reason for revision surgery was adjacent segment disease (ASD) in 28 (53.8%),pseudoarthrosis in 10 (19.2%), hardwarerelated problems in 4 (7.7%), both ASD and pseudoarthrosis in 3 (5.8%),infection in 3 (5.8%)and other segmental disease in 4 (7.7%) of those patients.The need for revision surgery was unaffected by age, sex, height, weight, body mass index, status of diabetes mellitus, symptoms at presentation, and graft type (p>0.05).The statistical significance of revision surgery was confirmed in patients with multisegment fusion level (3 levels, p=0.048) and smoking patients (p<0.001). Conclusion:Multi-segment fusion should be avoided, and smoking should be ceased during the perioperative period to reduce the risk of revision surgery when considering ACDF for degenerative cervical spine diseases.