Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases: A population-based cohort study in Taiwan

[[abstract]]BACKGROUND CONTEXT: The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. PURPOSE: To compare the reop rates and safety of ACDF and LMP for MCDD treatment. STUDY DESIGN: A retrospective population-based cohort study. PATIENT SAMPLE: Patients who underwent ACDF and LMP treatment. OUTCOME MEASURES: Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. METHODS: 6605 patients who underwent ACDF and 1578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. RESULTS: Long-term reop rates (per 100 person-month) was slightly higher in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03-0.05]) than those who underwent LMP (0.06 [95% CI: 0.04-0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI, 0.96-2.11, P=0.08) although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33-0.51]) than in the ACDF group (0.09 [95% CI: 0.07-0.11]), with adjusted HR of 4.81(95% CI, 3.46-6.69, P<0.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR = 2.07, 95% CI, 1.40-3.06, P