Comparison Between Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion of 1-2 Levels from 2002-2009.

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: 2.45). 10/2013; DOI: 10.1097/BRS.0000000000000044
Source: PubMed

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: Cervical disc arthroplasty (CDA) is a novel motion-preserving procedure that is an alternative to fusion. The Mobi-C disc prosthesis, one of many Food and Drug Administration (FDA)-approved devices for CDA, is the only FDA-approved prosthesis for two-level CDA. Hence, it may allow for improved outcomes compared with multilevel fusion procedures. To critically assess the available literature on CDA with the Mobi-C prosthesis, with a focus on two-level CDA. All clinical articles involving the Mobi-C disc prosthesis for CDA through September 1, 2014 were identified on Medline. Any paper that presented Mobi-C CDA clinical results was included. Study design, sample size, length of follow-up, use of statistical analysis, quality of life outcome scores, conflict of interest, and complications were recorded. Fifteen studies were included that investigated Mobi-C CDA, only one of which was a level Ib randomized control trial. All studies included showed non-inferiority of one-level Mobi-C CDA to one-level anterior cervical discectomy and fusion (ACDF). Only one study analyzed outcomes of one-level versus two-level Mobi-C CDA, and only one study analyzed two-level Mobi-C CDA versus two-level ACDF. In comparison with other cervical disc prostheses, the Mobi-C prosthesis is associated with higher rates of heterotopic ossification (HO). Studies with conflicts of interest reported lower rates of HO. Adjacent segment degeneration or disease, along with other complications, were not assessed in most studies. One-level Mobi-C CDA is non-inferior, but not superior, to one-level ACDF for patients with cervical degenerative disc disease. The Mobi-C CDA procedure is associated with high rates of HO. Two-level Mobi-C CDA may be superior to two-level ACDF. However, insufficient evidence exists, thereby mandating a need for unbiased, well-designed prospective studies with well-defined outcomes in the future.
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