Comparison Between Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion of 1-2 Levels from 2002-2009.
ABSTRACT 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.
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ABSTRACT: The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.Journal of Chronic Diseases 02/1987; 40(5):373-83.
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ABSTRACT: The basic objective of this paper is to evaluate an age-comorbidity index in a cohort of patients who were originally enrolled in a prospective study to identify risk factors for peri-operative complications. Two-hundred and twenty-six patients were enrolled in the study. The participants were patients with hypertension or diabetes who underwent elective surgery between 1982 and 1985 and who survived to discharge. Two-hundred and eighteen patients survived until discharge. These patients were followed for at least five years post-operatively. The estimated relative risk of death for each comorbidity rank was 1.4 and for each decade of age was 1.4. When age and comorbidity were modelled as a combined age-comorbidity score, the estimated relative risk for each combined age-comorbidity unit was 1.45. Thus, the estimated relative risk of death from an increase of one in the comorbidity score proved approximately equal to that from an additional decade of age. The combined age-comorbidity score may be useful in some longitudinal studies to estimate relative risk of death from prognostic clinical covariates.Journal of Clinical Epidemiology 12/1994; 47(11):1245-51. · 5.33 Impact Factor
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ABSTRACT: The age-dependent occurrence of cervical degenerative changes was studied using 0.1 T MRI in 89 asymptomatic volunteers aged 9 to 63 years. The degree of DD (disc darkening on T2*-weighted images), disc protrusions and prolapses, narrowing of disc spaces, dorsal osteophytes and spinal canal stenosis were assessed. Abnormalities were commoner in older subjects, 62% of being seen in those over 40 years old. In subjects aged less than 30 years there were virtually no abnormalities. DD was the most common abnormality, seen in 10% of discs; 57% DD was in subjects aged over 40. DD at the C5/6 level was the most common finding. No differences in abnormal findings between males and females was observed, nor any statistically significant association between DD and other abnormalities. Thus, DD begins later age in the cervical spine than in the lumbar region. Asymptomatic degenerative changes are common on MRI in the cervical spine after 30 years of age.Neuroradiology 02/1994; 36(1):49-53. · 2.70 Impact Factor