Background/Objectives: The etiology of lumbar spine revision surgery is multifactorial, involving mechanical, biological, and clinical factors that challenge sustained spinal stability. Comparative analysis reveals significantly higher complication rates, prolonged hospital stays, and increased costs for revision surgeries compared to primary fusions, despite low mortality rates. Leveraging a comprehensive dataset of 456,750 patients, this study identifies predictors of revision surgery and provides actionable insights to enhance patient outcomes and optimize healthcare resource allocation. Methods: A total of 456,750 patients registered in the National Inpatient Sample (NIS) database from 2016 to 2019 were identified as having undergone single-level lumbar fusion surgery (primary fusion: 99.5%; revision fusion: 0.5%). Multivariable logistic regression models adjusted for patient demographics, clinical comorbidities, and hospital characteristics were constructed to evaluate clinical outcomes and postoperative complications. Results: Patients undergoing revision lumbar fusion surgery were significantly younger compared to those undergoing primary fusion procedures (53.92 ± 20.65 vs. 61.87 ± 12.32 years, p < 0.001); among the entire cohort, 56.4% were women. Compared with patients undergoing primary lumbar fusion, those undergoing revision fusion surgery were significantly more likely to experience surgical site infections (odds ratio [OR] 27.10; 95% confidence interval [95% CI] 17.12–42.90; p < 0.001), urinary tract infections (OR 2.15; 95% CI 1.39–3.33; p < 0.001), and prolonged length of stay (OR 1.53; 95% CI 1.24–1.89; p < 0.001). Revision surgery patients had significantly lower odds of incurring high-end hospital charges (OR 0.65; 95% CI 0.51–0.83; p < 0.001). Other complications, including respiratory complications, dural tears, thromboembolic events, and acute renal failure, showed no statistically significant differences between the two groups. In-hospital mortality rates were low and did not differ significantly between groups (revision: 0.2% vs. primary: 0.1%, OR 3.29; 95% CI 0.45–23.84; p = 0.23). Conclusions: Patients undergoing revision lumbar fusion surgeries face significantly higher risks of surgical site infections, urinary tract infections, and prolonged hospital stays compared to primary fusion procedures. These findings highlight the need for targeted interventions to improve perioperative management and reduce complications in revision lumbar fusion surgery.

Introduction: Cervical disc disease is a common cause of disability worldwide. Two surgical options for refractory CDD are anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). While ACDF is well established, CDA offers motion preservation and has shown promising outcomes. This study compared utilization trends, patient characteristics, and hospitalization outcomes of ACDF and CDA using a large national dataset. Methods: We analyzed patients in the Nationwide Inpatient Sample (2016–2019) undergoing ACDF or CDA, identified using ICD-10 codes. After exclusions, 97,999 patients were included. Propensity score matching yielded 11,415 pairs, enabling balanced comparisons of demographics, comorbidities, complications, length of stay (LOS), and hospital charges. Results: CDA utilization increased during the study period. Compared with ACDF, CDA patients were younger and more likely to have private insurance. Following matching, both groups were demographically similar. CDA was associated with a slightly shorter LOS (1.32 vs. 1.39 days) but significantly higher charges (USD 82,431 vs. USD 58,472). In terms of complications, dysphagia was more frequent after ACDF, whereas cervical spinal cord injury and urinary tract infections were slightly more common after CDA, though rare overall. Conclusions: CDA is increasingly adopted in younger, privately insured patients and demonstrates comparable safety with ACDF. Its advantages include motion preservation, shorter hospitalization, and lower dysphagia rates, though at the expense of higher costs. These findings support the selective use of CDA as a viable alternative to ACDF in appropriately chosen patients.

Introduction: Cervical disc diseases (CDD) are a significant cause of disability and diminished quality of life globally, with prevalence increasing with age. Two common surgical interventions for symptomatic CDD patients who do not respond to conservative treatments are Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Disc Arthroplasty (CDA). While ACDF is more established and has a more extended history of use, CDA has been gaining popularity due to its motion-preserving benefits and comparable, if not superior, long-term outcomes. This study aims to compare these two procedures using a comprehensive dataset of 97,999 patients, focusing on patient demographics, complications, costs, length of hospital stay, and mortality rates to contribute valuable insights that can inform clinical practice and healthcare policy. Methods: In this study, data were sourced from the Nationwide Inpatient Sample (NIS) database, covering the period from January 1st, 2016, to December 31st, 2019. The dataset comprised 97,999 patients, with 85,584 undergoing ACDF and 11,415 CDA. Patients were identified using ICD-10 codes, with exclusions for non-elective admissions and surgeries performed prior to admission. Statistical analyses, including crosstabs and t-tests, were conducted, with a significance level of p < 0.05. Propensity score matching was utilized to control selection bias, resulting in a refined cohort of 11,415 matched pairs. Comorbidities and clinical outcomes were analyzed using the NIS dataset, including mortality, length of stay, complications, and hospitalization costs. Results: The study observed a significant increase in the utilization of CDA surgeries compared to ACDF from 2016 to 2019. ACDF patients were older (55.6 vs. 47.2 years, P< 0.001) and more likely to have Medicare coverage (33.9% vs. 10.7%, P< 0.001). Comorbidities such as hypertension, dyslipidemia, and diabetes mellitus were more prevalent in ACDF patients (P< 0.001). Propensity score matching balanced both groups, confirming comparable demographic and comorbidity profiles, with no significant differences in major conditions like hypertension (P=0.59) and dyslipidemia (P=0.93). Hospitalization outcomes revealed a slightly longer length of stay for ACDF (1.39 vs. 1.32 days, P< 0.001), while CDA incurred higher mean charges ($82,431 vs. $58,472, P< 0.001). Postoperatively, ACDF patients experienced more dysphagia (4.90% vs. 3.60%, P< 0.001), venous thromboembolism (0.13% vs. 0.04%, P=0.03), and sepsis (0.04% vs. 0.00%, P=0.03). Cervical spinal cord injury and urinary tract infections were more frequent in the CDA group (P=0.04 and P=0.02, respectively). Conclusions: This study highlights a growing trend in favor of CDA, particularly among younger patients and those with private insurance. The advantages of motion preservation, reduced adjacent-segment disease, shorter hospital stays, and lower complication rates make CDA an increasingly viable alternative to traditional ACDF, despite its higher initial costs. These findings align with recent literature, further supporting the adoption of CDA in appropriate patient populations.

Introduction: The etiology of lumbar spine revision surgery is multifactorial, involving mechanical, biological, and clinical factors that challenge sustained spinal stability. Comparative analysis reveals significantly higher complication rates, prolonged hospital stays, and increased costs for revision surgeries compared to primary fusions despite low mortality rates. Leveraging a comprehensive dataset of 456,750 patients, this study identifies predictors of revision surgery and provides actionable insights to enhance patient outcomes and optimize healthcare resource allocation. Methods: A total of 456,750 patients registered in the National Inpatient Sample (NIS) database from 2016 to 2019 were identified as having undergone single-level lumbar fusion surgery (primary fusion: 99.5%; revision fusion: 0.5%). Multivariable logistic regression models adjusted for patient demographics, clinical comorbidities, and hospital characteristics were constructed to evaluate clinical outcomes and postoperative complications. Results: Patients undergoing revision lumbar fusion surgery were significantly younger compared to those experiencing primary fusion procedures (53.92 ± 20.65 vs. 61.87 ± 12.32 years, P < 0.001); among the entire cohort, 56.4% were women. Compared with patients undergoing primary lumbar fusion, those undergoing revision fusion surgery were significantly more likely to experience surgical site infections (odds ratio [OR] 27.10; 95% confidence interval [95% CI] 17.12–42.90; P < 0.001), urinary tract infections (OR 2.15; 95% CI 1.39–3.33; P < 0.001), and prolonged length of stay (OR 1.53; 95% CI 1.24–1.89; P < 0.001). Revision surgery patients had significantly lower odds of incurring high-end hospital charges (OR 0.65; 95% CI 0.51–0.83; P < 0.001). Other complications, including respiratory complications, dural tears, thromboembolic events, and acute renal failure, showed no statistically significant differences between the two groups. In-hospital mortality rates were low and did not differ significantly between groups (revision: 0.2% vs. primary: 0.1%, OR 3.29; 95% CI 0.45–23.84; P = 0.23). Conclusions: Patients undergoing revision lumbar fusion surgeries face significantly higher risks of surgical site infections, urinary tract infections, and prolonged hospital stays compared to primary fusion procedures. These findings highlight the need for targeted interventions to improve perioperative management and reduce complications in revision lumbar fusion surgery.