Comparison Between Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion of 1 to 2 Levels From 2002 to 2009
Research Coordinator, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.Spine (Impact Factor: 2.3). 10/2013; 39(1). DOI: 10.1097/BRS.0000000000000044
Study Design. Retrospective database analysisObjective. To compare the perioperative patient characteristics, early postoperative outcomes, and costs between an anterior cervical discectomy and fusion versus a cervical total disc replacement surgery in the United States.Summary of Background Data. Cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) are indicated to treat symptomatic cervical degenerative pathology. The epidemiology, complication rates, and the cost differences between the two surgical approaches are not well characterized.Methods. Data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project was queried from 2002-2009. Patients undergoing a cervical TDR or 1-2 level ACDF were identified. Patient demographics, comorbidities, length of stay (LOS), costs, and the in-hospital complications were assessed. SPSS v.20 was utilized for statistical analysis with χ test for categorical data and Independent-Samples T test for continuous data. A p-value of ≤0.001 denoted statistical significance. Multinomial regression analysis was utilized to identify the independent risk for complications in the TDR cohort compared to the ACDF cohort.Results. There were 141,230 1-2 level ACDFs and 1,830 cervical TDRs identified in the NIS database. The ACDF cohort was older and demonstrated a greater comorbidity burden compared to the TDR group (p<0.001). The ACDF treated patients demonstrated a significantly greater LOS than the TDR group (p<0.001). In contrast, there were no significant differences in incidences of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques.Conclusion. The ACDF cohort was significantly older and demonstrated a greater comorbidity burden which likely contributed to the greater length of stay (LOS) when compared to the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications and costs. There were no significant differences in the risks for postoperative complications between the surgical cohorts. Further studies are warranted to characterize the long term complications, costs, and patient outcomes between the two surgical techniques.
Article: Cervical artificial disc replacement[Show abstract] [Hide abstract]
ABSTRACT: Cervical disc replacement has recently become available in the United States and is gaining notoriety. It is widely publicized throughout the media and medical journals. Despite this, few clinicians are familiar with the actual indications for cervical disc arthroplasty. The role of disc replacement is somewhat of an enigma when treating cervical pathology. This article is intended to describe the procedure of cervical artificial disc replacement and address its appropriate use. The indications have been reviewed along with discussion regarding which patients may benefit from this surgical procedure.Techniques in Regional Anesthesia [amp ] Pain Management 04/2013; 17(2):32–35. DOI:10.1053/j.trap.2014.01.004
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ABSTRACT: Study Design. A Markov transition state model was developed to evaluate the cost-effectiveness of Anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) at five years.Objective. To determine the cost-effectiveness of ACDF and CDR at five years.Introduction. ACDF and CDR are surgical options for the treatment of an acute cervical disc herniation with associated myelopathy/radiculopathy. Cost-effectiveness analysis (CEA) provides valuable information regarding which intervention will lead to a more efficient utilization of healthcare resourcesMethods. Outcome and complication probabilities were obtained from existing literature. Physician costs were based on a fixed percentage of 140% of 2010 Medicare reimbursement. Hospital costs were determined from the Nationwide Inpatient Sample (NIS). Utilities were derived from responses to health state surveys (Short Form 36) at baseline and at 5 years from the treatment arms of the Prodisc-C trial. Incremental cost effectiveness ratios (ICER) were used to compare treatments. One-way sensitivity analyses were performed on all parameters within the model.Results. CDR generated a total five-year cost of $102,274, while ACDF resulted in a five-year cost of $119,814. CDR resulted in a generation of 2.84 QALY's, whereas ACDF resulted in 2.81. The ICER was -$557,849 per QALY gained. CDR remained the dominant strategy below a cost of $20,486. ACDF was found to be a cost-effective strategy below a cost of $18,607. CDR was the dominant strategy when the utility value was above 0.713. CDR remained the dominant strategy assuming an annual complication rate less than 4.37%.Conclusions. ACDF and CDR were both shown to be cost effective strategies at five years. CDR was found to be the dominant treatment strategy in our model. Further long-term studies evaluating the clinical and quality of life outcomes of these two treatments are needed to further validate the model.Spine 08/2014; 39(23). DOI:10.1097/BRS.0000000000000562 · 2.30 Impact Factor
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ABSTRACT: Study Design. Cost-effectiveness analysis with decision analysis and meta-analysisObjective. To determine the relative cost-effectiveness of anterior cervical discectomy with fusion (ACDF) (with autograft, allograft or spacers), anterior cervical discectomy without fusion (ACD) and cervical disc replacement (CDR) for the treatment of one-level cervical disc disease.Summary of Background Data. There is debate as to the optimal anterior surgical strategy to treat single-level cervical disc disease. Surgical strategies include three techniques of ACDF (autograft, allograft or spacer-assisted fusion), ACD and CDR. Several controlled trials have compared these treatments but have yielded mixed results. Decision analysis provides a structure for making a quantitative comparison of the costs and outcomes of each treatment.Methods. A literature search was performed and yielded 156 case series that fulfilled our search criteria describing nearly 17,000 cases. Data were abstracted from these publications and pooled meta-analytically to estimate the incidence of various outcomes, including index-level and adjacent-level reoperation. A decision analytic model calculated the expected costs in U.S. dollars and outcomes in quality-adjusted life years (QALYs) for a typical adult patient with one-level cervical radiculopathy subjected to each of the five approaches.Results. At five years postoperatively, patients who had undergone ACD alone had significantly (p < 0.001) more QALYs (4.885 ± 0.041) than those receiving other treatments. ACD patients also exhibited highly significant (p <0.001) differences in costs, incurring the lowest societal costs ($16,558 ± 539). Follow-up data were inadequate for comparison beyond five years.Conclusions. The results of our decision analytic model indicate advantages for ACD, both in effectiveness and costs, over other strategies. Thus, ACD is a cost-effective alternative to ACDF and CDR in patients with single-level cervical disc disease. Definitive conclusions about degenerative changes after ACD and adjacent-level disease after CDR await longer follow-up.Spine 09/2014; 39(25). DOI:10.1097/BRS.0000000000000612 · 2.30 Impact Factor
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