Increased Cumulative Incidence of 10-Year Reoperation and Surgical Complications Following Anterior Cervical Discectomy and Fusion Compared With Cervical Disc Arthroplasty

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare 10-year survivorship, secondary cervical procedure rates, and surgical complications between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: ACDF is the traditional gold-standard treatment for cervical spine degeneration but alters adjacent segment motion, potentially accelerating degeneration. CDA has emerged as a motion-preserving alternative that may reduce adjacent segment disease. While short- and mid-term studies suggest comparable outcomes, limited data exist on long-term complications and survivorship beyond 10 years. METHODS: Patients undergoing primary single-level CDA and ACDF between 2010 and 2022 were identified from a national claims database. CDA patients were propensity-score matched 1:1 to ACDF patients by age, sex, and Charlson Comorbidity Index. Kaplan-Meier survival analysis was used to determine the 10-year cumulative incidence of secondary cervical procedures, including ACDF, CDA, cervical decompression, and posterior fusion. Complications such as all-cause revision, hardware removal, spinal complications, nerve root compression, dural tear, dysphonia, dysphagia, drainage and evacuation, and mechanical failure were analyzed. Cox proportional hazards models estimated hazard ratios (HR) with 95% CIs. RESULTS: A total of 18,192 CDA patients were matched to 18,192 ACDF patients. At 10 years, the cumulative incidence of secondary procedures was lower for CDA (8.7%) compared with ACDF (11.4%), with ACDF patients more likely to undergo reoperation (HR: 1.12, P=0.005). ACDF patients also demonstrated higher risks of spinal complications (4.73), nerve root compression (HR: 2.61), drainage and evacuation (HR: 2.01), and mechanical failure (HR: 1.36), all statistically significant (P<0.05). CONCLUSIONS: CDA demonstrated superior long-term outcomes compared with ACDF by reducing secondary procedures and complication rates over 10 years. These findings suggest motion preservation with CDA translates into sustained clinical benefit. Surgeons should incorporate this evidence when counseling patients regarding surgical options for single-level cervical degeneration.