title: Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases: a population-based cohort study in Taiwan.
abstract: 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.
  
  
  
  This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment.
  
  
  
  This is a retrospective population-based cohort study.
  
  
  
  Our sample consists of patients who underwent ACDF and LMP treatment.
  
  
  
  Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death.
  
  
  
  A total of 6,605 patients who underwent ACDF and 1,578 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.
  
  
  
  Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03-0.05]) than in 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=.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<.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<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12-9.54, p=.03) was associated with reop risk in the patients who underwent LMP.
  
  
  
  There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.
authors: Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
authors: Jiann-Her
authors: JH
authors: Lin
authors: School of Health Care Administration, College of Management, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Health and Clinical Research Center, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
authors: Li-Nien
authors: LN
authors: Chien
authors: Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
authors: Wan-Ling
authors: WL
authors: Tsai
authors: Health and Clinical Research Center, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
authors: Li-Ying
authors: LY
authors: Chen
authors: Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan. Electronic address: ychsieh@tmu.edu.tw.
authors: Yi-Chen
authors: YC
authors: Hsieh
authors: Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
authors: Yung-Hsiao
authors: YH
authors: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D065406:Laminoplasty / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013624:Taiwan; D016896:Treatment Outcome
keywords: Anterior cervical discectomy and fusion; Cervical spondylotic myelopathy; Complication; Laminoplasty; Multilevel cervical degenerative diseases; Reoperation