Optimizing Spine Surgery: Comparing Procedures and Perioperative Influences

CDA vs ACDF shows greater midterm durability than fusion for single-level cervical degenerative disc disease, with lower reoperation rates and less adjacent-segment degeneration when a device-preserving strategy is used.

In a single-segment cohort with a minimum four-year follow-up, the study reports lower reoperation and device-related revision rates and a reduced rate of adjacent segment degeneration, favoring motion-preserving intervention over fusion.

Which modifiable perioperative factors shift these outcomes? Key targets include smoking cessation, optimization of cardiometabolic comorbidities and glycemic control, opioid-sparing analgesia, and careful wound care. Elements aligned with enhanced recovery after surgery—standardized multimodal analgesia, early mobilization, and clear discharge criteria—are associated with shorter stays and faster functional recovery in spine cohorts and may reduce downstream reoperation burden when combined with perioperative risk reduction.

These findings should inform shared decision-making, motivate longer-term comparative-effectiveness follow-up (registries and cohort surveillance), and encourage routine incorporation of ERAS elements and modifiable-risk reduction into perioperative pathways—measures that will refine device selection and patient counseling going forward.

Key Takeaways:

• CDA demonstrates lower midterm reoperation rates and less adjacent-segment degeneration than ACDF in single-level degenerative disease, implying greater midterm durability.
• Patients with single-level cervical degenerative disc disease who are eligible for motion-preserving implants may experience lower reoperation risk and preserved adjacent-segment integrity.
• Include device selection in risk–benefit discussions and prioritize perioperative optimization—smoking cessation, metabolic control, and ERAS components—to improve early recovery and potentially reduce reoperation.