ACDF Associated with Increased Positive Outcome Rates in Geriatric Patients with Cervical Disc Herniation Compared to PCDF

Introduction: Discharge planning following Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Decompression and Fusion (PCDF) surgeries is crucial, especially given the postoperative care required for geriatric patients. However, a significant gap remains in understanding how demographic and clinical characteristics influence discharge destinations in this population. This study aims to fill this void by identifying key factors determining discharge outcomes.

Methods: A database including 8,622 spine surgery patients was collected for a period of 10 years at a single institution. Age, sex, ethnicity, BMI, insurance, surgery type, American Society of Anaesthesiologists (ASA) Classification, and Elixhauser comorbidity index (ECI) were considered. Multivariable Linear Regression analysis controlled for demographic, clinical, and comorbidity factors while examining hospital discharge disposition dichotomized into good outcome (home or acute rehabilitation disposition) or poor outcome (discharge to skilled nursing facility/subacute rehabilitation or in-hospital mortality).

Results: In a cohort of 282 geriatric patients with cervical disc herniation, 221 (78.4%) underwent ACDF procedures and 61 (21.6%) PCDF, both interventions spanning 2-4 levels. The cohort’s mean age was 71.3±5.6 years, with no significant differences in age, gender, ethnicity, or BMI between the two surgical groups. Multivariate analysis showed that ACDF was associated with increased positive outcomes compared to PCDF (86% vs 64%; p=0.001; β=0.176). Age (p < 0.001; β=0.017), female sex (p=0.004; β=0.126), ASA (p=0.009; β=0.105), and ECI (p < 0.001; β=0.056) were also associated with increased good outcomes. Race, insurance status, and BMI were not associated with worse outcomes.

Conclusion : Among geriatric patients with cervical disc herniation, ACDF procedures demonstrated a higher likelihood of positive outcomes compared to PCDF. These findings provide pivotal insights for neurosurgical decision-making, emphasizing the potential benefits of ACDF in optimizing postoperative results for this patient demographic.