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
Source: PubMed


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.

15 Reads
  • [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
  • [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    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.
    Medical Devices: Evidence and Research 11/2014; 7:397-403. DOI:10.2147/MDER.S54497