Single-level cervical disc arthroplasty is associated with higher early subsequent surgery rates and similar adjacent segment disease rates compared with anterior cervical discectomy and fusion.

BACKGROUND: Cervical disc arthroplasty (CDA) is a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), but its comparative long-term durability remains debated. This study aimed to compare short- and long-term postoperative outcomes following single-level CDA versus ACDF. METHODS: A retrospective propensity-matched cohort study was performed using a large national administrative database. Adult patients undergoing single-level CDA or ACDF without prior spine surgery were identified and matched 1:1, yielding 3,138 patients per cohort. Outcomes were assessed at 1, 2, 5, and 10 years postoperatively. RESULTS: At 1 year, CDA was associated with lower rates of pulmonary embolism/deep venous thrombosis (PE/DVT) [0.6% vs. 1.2%; risk ratio (RR) 0.526, P=0.02] and neurovascular injury (0.4% vs. 1.3%; RR 0.333, P<0.001), while other short-term complications were similar. At 2 and 5 years, CDA demonstrated higher rates of subsequent cervical spine surgery (1.5% vs. 0.7%, P=0.003; 1.9% vs. 1.1%, P=0.02), although this difference was no longer significant at 10 years. CDA also showed lower long-term rates of infection, PE/DVT, and nerve injury. No significant differences were observed in adjacent segment disease (ASD) or cervical spondylolisthesis. CONCLUSIONS: Single-level CDA was associated with higher early revision and subsequent surgery rates and similar ASD rates compared with ACDF. Although CDA showed lower rates of select complications, these differences may not outweigh the increased intermediate-term reoperation burden.