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Gupta P, Hassan FM, Thomas GM, Lombardi JM, Sardar ZM. Influence of Surgeon Specialty on 30-day Outcomes Following Single-Level Cervical Disc Arthroplasty: A Propensity-Matched Analysis. Global Spine J 2024; 14:1257-1268. [PMID: 36350144 PMCID: PMC11289565 DOI: 10.1177/21925682221139436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN Retrospective, propensity-matched analysis. OBJECTIVES Cervical disc arthroplasty (CDA) is being increasingly utilized for cervical disc generation. Surgeon specialty has been shown to influence the risk for postoperative complications in spine surgery, but this has not yet been explored for CDA. Thus, the purpose of this study is to determine whether there is any difference in 30-day complications between patients undergoing single-level CDA by neurosurgeons vs by orthopaedic surgeons. METHODS A retrospective, 1:1 propensity score matched analysis was performed using the NSQIP database from 2015 to 2020. Patient demographics, operative characteristics, and postoperative complications were recorded. Independent multivariate logistic regression models were constructed using the propensity-matched dataset to assess surgical specialty influence on any complication, any site complication, any operative infection, and any medical complications. RESULTS 3179 single-level CDAs (28.8% orthopaedic surgery patients, 71.2% neurosurgery patients) were identified that met the inclusion criteria. Well-matched cohorts of 916 patients each were generated. After controlling for all possible confounders, orthopedic surgery specialty was not associated with a higher odds for any complication (OR: .87, 95% CI: .35 - 2.20, P = .7696), any site complication (OR: .32, 95% CI: .08 - 1.32, P = .1359), any operative infection (OR: .31, 95% CI: .07 - 1.34), P = .1172), nor any medical complication (OR: 2.11, 95% CI: .62 - 7.20, P = .2311) vs neurosurgery. CONCLUSION This is the first propensity-matched analysis to show that spine surgeon specialty does not influence the risk for any complication, any site complication, any operative infection, nor any medical complication following single-level CDA within the first 30 days after surgery.
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Affiliation(s)
- Puneet Gupta
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Fthimnir M Hassan
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - George M Thomas
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Zhu Q, Li N, Ding Y, Zhang Z, Jiang W, Jiang T, Qiao Q, Qian Y, Cheng H. Incidence of Adjacent Segment Degeneration and Its Associated Risk Factors Following Anterior Cervical Discectomy and Fusion: A Meta-Analysis. World Neurosurg 2024; 183:e153-e172. [PMID: 38103684 DOI: 10.1016/j.wneu.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the incidence of adjacent segment degeneration (ASD) and its associated risk factors in adults after anterior cervical discectomy and fusion (ACDF) surgery. METHODS An exhaustive search across multiple databases was conducted, including Embase, PubMed, Cochrane Library, and the Web of Science, to identify pertinent studies. We collected such patient data as demographic variables (including age, gender, body mass index), cervical spondylosis type (such as radiculopathy and myelopathy), diabetes status, smoking and drinking history, and radiological risk factors (such as preoperative ASD status, developmental spinal stenosis, T1 slope, and postoperative less cervical lordosis). Incidence estimates were calculated based on relevant data. Risk factors were assessed using odds ratios and weighted mean differences with 95% confidence intervals (CIs). RESULTS Our analysis incorporated a total of 21 studies for incidence analysis. The overall incidence of CASD following ACDF was found to be 11% and radiographical ASD was 30%. Old age (weighted mean difference = 3.21; 95% CI: 0.06, 6.36; P = 0.05), preoperative ASD status (odds ratio = 2.65; 95% CI: 1.53, 4.60; P < 0.01), developmental spinal stenosis (odds ratio = 2.46; 95% CI: 1.61, 3.77; P < 0.01), and postoperative reduction in cervical lordosis were identified as significant risk factors for the occurrence of CASD. CONCLUSIONS The incidence of CASD following ACDF was 11%. Risk factors for CASD included old age, preoperative adjacent segment degeneration, developmental spinal stenosis, and postoperative reduction in cervical lordosis. These findings provide valuable insights for the assessment of adjacent segment disease risk after ACDF, aiding surgeons in diagnosis and treatment decisions.
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Affiliation(s)
- Qianmiao Zhu
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ning Li
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yi Ding
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zifeng Zhang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Wenkang Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ting Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Qiujiang Qiao
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yuhang Qian
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Huilin Cheng
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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Chen S, Suo S, Xie Z, He J, Li J, Duan D, Qiao G, Zhang W. Establishment of an animal model of adjacent segment degeneration after interbody fusion and related experimental studies. J Orthop Surg Res 2023; 18:666. [PMID: 37679790 PMCID: PMC10483717 DOI: 10.1186/s13018-023-04072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Degenerative spine conditions are common and frequent clinical diseases, and adjacent segment disease (ASD) after spinal fusion (SF) is a common complication after spinal fusion (SF). In this study, we established an animal model of ASD after interbody fusion to observe the morphologic changes of adjacent segment (AS) disks and to determine the expression and significance of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) in ASD tissues to provide a good experimental basis and reference for clinical prevention and treatment of ASD after interbody fusion. METHODS Thirty-six male and female New Zealand rabbits weighing 2.0-2.5 kg were randomly divided into control group (group A) and experimental groups (groups B, C, and D), with 9 rabbits in each group, of which groups B, C, and D were the 4-, 8-, and 12-week groups, respectively. Autologous iliac bone grafts were used as the bone graft material. In the experimental groups, a SF was performed on the C2-C3 intervertebral space. The C3-4 adjacent segments were examined. In the experimental group, the animals were subjected to gross observation, X-ray examination, hand touch inspection, and micro-computed tomography (micro-CT) 4, 8, and 12 weeks after surgery. The micromorphologic changes of the cervical disks in the segments of the control group and experimental groups were observed under light microscopy. Immunohistochemistry and Western blotting were used to detect the expression of TNF-α and IL-1β in the AS tissues after interbody fusion in the control and experimental groups. RESULTS The measurement data of the rabbit cervical spine bony structures indicated that the length of the vertebral body and the sagittal diameter of the lower end of the vertebral body decreased gradually from the 2nd-6th cervical vertebrae, and the difference was statistically significant (P < 0.05). The difference in the transverse diameter of the lower end of the vertebral body was not statistically significant (P > 0.05), the change in the oblique diameter of the lower end of the vertebral body fluctuated, and the difference was statistically significant (P < 0.05). The fusion rate of the cervical spine by hand touch inspection was 22.2% (2/9), 55.6% (5/9), and 88.9% (8/9) in groups B, C, and D, respectively. The differences in bone volume-to-total volume (BV/TV) and X-ray scores were statistically significant in groups B, C, and D (P < 0.05). Significant degeneration occurred in groups B, C, and D compared with group A. The expression of TNF-α and IL-1β in the intervertebral disk tissue was significantly higher in groups B, C, and D compared with group A (P < 0.05), and increased with time. CONCLUSION In this study, an animal model of ASD after interbody fusion fixation in rabbits was successfully established. Postoperative imaging and hand touch inspection showed a positive correlation between the amount of new intervertebral bone and the degree of fusion with time. The results of immunohistochemistry and Western blot showed that TNF-α and IL-1β were highly expressed in the AS tissues of the experimental group after interbody fusion, and the degree of disk degeneration was positively correlated with the time after interbody fusion.
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Affiliation(s)
- Song Chen
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China.
| | - Shiqi Suo
- Department of Gynecology, The Affiliated Hospital of Hebei Engineering University, Handan, 056000, China
| | - Zhitao Xie
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China
| | - Jinglan He
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Zi-Qiang Road, Shijiazhuang, 050000, Hebei, China
| | - Dengke Duan
- Department of Orthopaedics, Handan First Hospital, Handan, 056000, China
| | - Guoyong Qiao
- Department of Orthopaedics, The Affiliated Hospital of Hebei Engineering University, No. 81, Congtai Road, Congtai District, Handan, 056000, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Zi-Qiang Road, Shijiazhuang, 050000, Hebei, China.
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Kuruba V, Cherukuri AMK, Arul S, Alzarooni A, Biju S, Hassan T, Gupta R, Alasaadi S, Sikto JT, Muppuri AC, Siddiqui HF. Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders. Cureus 2023; 15:e45962. [PMID: 37900519 PMCID: PMC10600402 DOI: 10.7759/cureus.45962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms of blood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include a prolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation rates and higher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties and develop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.
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Affiliation(s)
- Venkataramana Kuruba
- Department of Orthopedic Surgery, All India Institute of Medical Sciences, Vijayawada, IND
| | | | - Subiksha Arul
- Department of Medicine, JONELTA Foundation School of Medicine, University of Perpetual Help System DALTA, Manila, PHL
| | | | - Sheryl Biju
- Department of Medicine, Christian Medical College, Vellore, IND
| | - Taimur Hassan
- Department of Medicine, Texas A&M College of Medicine, College Station, USA
| | - Riya Gupta
- Department of Medicine, Shri Atal Bihari Vajpayee Medical College and Research Institute, Bangalore, IND
| | - Saya Alasaadi
- Department of Medicine, University College of Dublin, Dublin, IRL
| | - Jarin Tasnim Sikto
- Department of Medicine, Jahurul Islam Medical College and Hospital, Bhagalpur, BGD
| | - Arnav C Muppuri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Humza F Siddiqui
- Department of Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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Brecount H, Goodwin A, Hiltzik DM, Hsu WK. The Role of Cervical Disc Arthroplasty in Elite Athletes. Curr Rev Musculoskelet Med 2023; 16:432-437. [PMID: 37436652 PMCID: PMC10427594 DOI: 10.1007/s12178-023-09858-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW Cervical disc arthroplasty (CDA) for the treatment of symptomatic cervical disc herniations (CDH) is a promising treatment for professional athletes. In recent years, a number of high-profile athletes have returned to professional play within three months after CDA, raising important questions about the potential of this procedure within this patient group. We provide the first comprehensive review of available literature for the safety and efficacy of CDA in professional contact sport athletes. RECENT FINDINGS CDA provides theoretical biomechanical advantages over anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), as CDA is the only operation for treatment of CDH that provides neural decompression, stability and height restoration, with preserved range of motion. While the comparative long-term results from each procedure are unknown, CDA has provided encouraging promise in its use in professional contact athletes. We aim to aid ongoing discussions regarding the controversies in spine surgery for professional athletes by providing a scientific review of the available evidence-based literature involving cervical disc arthroplasty in this population. In general, we believe that CDA is a viable alternative to ACDF and PF for the contact professional athlete who requires full neck range of motion and desires an expedited return to play. For collision athletes, the short- and long-term safety and efficacy profile of this procedure is promising but still unclear.
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Affiliation(s)
- Hogan Brecount
- Simpson Querrey Institute (SQI), Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA
- Department of Orthopaedic Surgery, Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA
| | - Alyssa Goodwin
- Simpson Querrey Institute (SQI), Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA
- Department of Orthopaedic Surgery, Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA
| | - David M Hiltzik
- Simpson Querrey Institute (SQI), Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA.
- Department of Orthopaedic Surgery, Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA.
| | - Wellington K Hsu
- Simpson Querrey Institute (SQI), Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA
- Department of Orthopaedic Surgery, Northwestern University, 1838 W Chicago Ave, Chicago, IL, 60622, USA
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McDonald CL, Alsoof D, Glueck J, Osorio C, Stone B, McCluskey L, Diebo BG, Daniels AH, Basques BA. Adjacent Segment Disease After Spinal Fusion. JBJS Rev 2023; 11:01874474-202306000-00007. [PMID: 37307327 DOI: 10.2106/jbjs.rvw.23.00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Adjacent segment disease is characterized by a degenerative process adjacent to a previously fused spine segment, with new onset of clinical symptoms such as radiculopathy, myelopathy, or instability.» Etiology is related to the natural history of the disease process, increased biomechanical stress at adjacent segments, clinical factors specific to the individual patient, intraoperative factors, and malalignment.» Treatment is usually nonoperative, but surgical intervention can be indicated. Decompression and fusion remain the mainstay of operative treatment, and isolated decompression should be considered in specific cases.» Further randomized controlled trials are needed to establish how the treatment should progress, particularly with the development of minimally invasive and endoscopic surgery.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jacob Glueck
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Camilo Osorio
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin Stone
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Leland McCluskey
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce A Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Steib JP, Dufour T, Beaurain J, Bernard P, Huppert J. Observational, Multicenter Study of the Efficacy and Safety of Cervical Disk Arthroplasty With Mobi-C in the Treatment of Cervical Degenerative Disk Disease. Results at 10 years Follow-Up. Spine (Phila Pa 1976) 2023; 48:452-459. [PMID: 36730682 DOI: 10.1097/brs.0000000000004536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical disk arthroplasty replacement (CDA) was developed to avoid specific disadvantages of cervical fusion. The purpose of this paper is to provide 10-year follow-up results of an ongoing prospective study after CDA. METHODS Three hundred eighty-four patients treated using the Mobi-C (ZimVie, Troyes, France) were included in a prospective multicenter study. Routine clinical and radiologic examinations were reported preoperatively and postoperatively with up to 10-year follow-up. Complications and revision surgeries were also documented. RESULTS At 10 years showed significant improvement in all clinical outcomes [Neck Disability Index, visual analog scale (VAS) for arm and neck pain, physical component summary of SF36, and mental component summary of SF36). Motion at the index level increased significantly over baseline (mean range of motion=7.6 vs. 8 degrees at five years and 6.0 degrees preoperatively; P <0.001) and 71.3% of the implanted segments remained mobile (range of motion>3 degrees). Adjacent disks were also mobile at 10 years with the same mobility as preoperatively. At 10 years, 20.9% of the implanted segments demonstrated no heterotopic ossification. Thirty-four patients (8.9%) experienced 41 adverse events, with or without reoperation during the first five years. We found only two additional surgeries after five years. We observed an increased percentage of working patients and a decrease in medication consumption. Regarding the overall outcome, 94% of patients were satisfied. CONCLUSIONS Our 10-year results showed significant improvement in all clinical outcomes, with low rates of revision or failure. This experience in patients with long-term follow-up after CDA endorses durable, favorable outcomes in properly selected patients.
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Affiliation(s)
| | - Thierry Dufour
- Parisian Institute, Geoffroy Saint-Hilaire Clinic, Paris, France
| | | | - Pierre Bernard
- Orthopaedic Department, Back Aquitain Center, Mérignac, France
| | - Jean Huppert
- Neuro-Surgery Department, Clinic of Parc, St-Priest-en-Jarez, France
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Kim KD, Coric D, Khachatryan A, Brady BL, Lillehaugen T, McCormack M, Dolman WB, Ditto R. A real-world analysis of hybrid CDA and ACDF compared to multilevel ACDF. BMC Musculoskelet Disord 2023; 24:191. [PMID: 36918916 PMCID: PMC10012503 DOI: 10.1186/s12891-023-06284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Multilevel anterior cervical discectomy and fusion (mACDF) is the gold standard for multilevel spinal disease; although safe and effective, mACDF can limit regular spinal motion and contribute to adjacent segment disease (ASD). Hybrid surgery, composed of ACDF and cervical disc arthroplasty, has the potential to reduce ASD by retaining spinal mobility. This study examined the safety of hybrid surgery by utilizing administrative claims data to compare real-world rates of subsequent surgery and post-procedural hospitalization within populations of patients undergoing hybrid surgery versus mACDF for multilevel spinal disease. METHODS This observational, retrospective analysis used the MarketScan Commercial and Medicare Database from July 2013 through June 2020. Propensity score matched cohorts of patients who received hybrid surgery or mACDF were established based on the presence of spinal surgery procedure codes in the claims data and followed over a variable post-period. Rates of subsequent surgery and post-procedural hospitalization (30- and 90-day) were compared between hybrid surgery and mACDF cohorts. RESULTS A total of 430 hybrid surgery patients and 2,136 mACDF patients qualified for the study; average follow-up was approximately 2 years. Similar rates of subsequent surgery (Hybrid: 1.9 surgeries/100 patient-years; mACDF: 1.8 surgeries/100 patient-years) were observed for the two cohorts. Hospitalization rates were also similar across cohorts at 30 days post-procedure (Hybrid: 0.67% hospitalized/patient-year; mACDF: 0.87% hospitalized/patient-year). At 90 days post-procedure, hybrid surgery patients had slightly lower rates of hospitalization compared to mACDF patients (0.23% versus 0.42% hospitalized/patient-year; p < 0.05). CONCLUSIONS Findings of this real-world, retrospective cohort study confirm prior reports indicating that hybrid surgery is a safe and effective intervention for multilevel spinal disease which demonstrates non-inferiority in relation to the current gold standard mACDF. The use of administrative claims data in this analysis provides a unique perspective allowing the inclusion of a larger, more generalizable population has historically been reported on in small cohort studies.
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Affiliation(s)
- Kee D Kim
- UC Davis Health, 4860 Y Street Suite, Sacramento, CA, 3740, 95817, USA
| | - Domagoj Coric
- Atrium Musculoskeletal Institute, Spine Division, Carolina Neurosurgery and Spine Associates, 225 Baldwin Avenue Charlotte, Charlotte, NC, 28204, USA
| | - Armen Khachatryan
- Orthopedic Spine Surgery, The Disc Replacement Center, 3584 West 9000 South #209, Salt Lake City, UT, 84088, USA
| | | | | | - Mike McCormack
- Zimmer Biomet, 1800 W Center Street, Warsaw, IN, 46580, USA
| | | | - Richard Ditto
- Zimmer Biomet, 1800 W Center Street, Warsaw, IN, 46580, USA
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Tu TH, Wang CY, Chen YC, Wu JC. Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions. J Neurosurg Spine 2023; 38:372-381. [PMID: 36681966 DOI: 10.3171/2022.11.spine22880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA-with low rates of complications-has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF-CDA according to individual evaluation for each level of degeneration.
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Affiliation(s)
- Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Ching-Ying Wang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Yu-Chun Chen
- 2Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
- 4Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
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Iyer S. In Patients with Cervical Radiculopathy, Arthroplasty and Fusion Surgical Treatment Did Not Differ for Disability at 5 Years. J Bone Joint Surg Am 2022; 104:942. [PMID: 35383662 DOI: 10.2106/jbjs.22.00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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11
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Economic Impact of Revision Operations for Adjacent Segment Disease of the Subaxial Cervical Spine. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00018. [PMID: 35452424 PMCID: PMC9042582 DOI: 10.5435/jaaosglobal-d-22-00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022]
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Kumar N, Liu ZJ, Poon WS, Park CK, Lin RM, Cho KS, Niu CC, Chen HY, Madhu S, Shen L, Sun Y, Mak WK, Lin CL, Lee SB, Park CK, Lee DC, Tung FI, Wong HK. ProDisc–C versus anterior cervical discectomy and fusion for the surgical treatment of symptomatic cervical disc disease: two-year outcomes of Asian prospective randomized controlled multicentre study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1260-1272. [DOI: 10.1007/s00586-021-07055-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022]
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Nunley P, Schouwen KFV, Stone M. Cervical Total Disc Replacement: Indications and Technique. Neurosurg Clin N Am 2021; 32:419-424. [PMID: 34538468 DOI: 10.1016/j.nec.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cervical total disc replacement devices have been marketed in the United States (US) since 2007, with abundant level 1 evidence published on the treatment. Adherence to the strict inclusion/exclusion criteria and the surgical technique training of the US clinical trials remains the consistent and conservative approach to patient selection and implantation technique. However, patient selection and surgical technique remain debated among US surgeons as the published data and available cervical total disc replacements continue to grow.
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Affiliation(s)
- Pierce Nunley
- Spine Institute of Louisiana, 1500 Line Avenue, Suite 200, Shreveport, LA 71101, USA.
| | | | - Marcus Stone
- Spine Institute of Louisiana, 1500 Line Avenue, Suite 200, Shreveport, LA 71101, USA
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Kim K, Hoffman G, Bae H, Redmond A, Hisey M, Nunley P, Jackson R, Tahernia D, Araghi A. Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial. Neurosurgery 2021; 88:497-505. [PMID: 33372218 DOI: 10.1093/neuros/nyaa459] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.
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Affiliation(s)
- Kee Kim
- Department of Neurological Surgery, UC Davis Health, Sacramento, California
| | | | - Hyun Bae
- The Spine Institute, Santa Monica, California
| | | | | | | | - Robert Jackson
- Orange County Neurosurgical Associates, Laguna Hills, California
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Wu T, Liu H, Wang B, Ding C, Meng Y, Rong X, Chen H, Yang Y, Hong Y, Huang K, He J. [Analysis of infuence factors of anterior bone loss after cervical disc arthroplasty and its effect on effectiveness]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:26-32. [PMID: 33448195 DOI: 10.7507/1002-1892.202008126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To explore the influence factors of anterior bone loss (ABL) after cervical disc arthroplasty (CDA) and effects of ABL on the clinical and radiographic outcomes. Methods One hundred and fifty-five patients who underwent single-level Prestige-LP CDA between January 2008 and December 2017 and met the inclusive criteria were enrolled in the study. Perioperative data of patients were collected. The Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and the visual analogue scale (VAS) score were used for clinical outcomes evaluation. Radiographic parameters including cervical lordosis, C 2-7 range of motion (ROM), disc angle, segmental ROM, and the lengths of the upper and lower endplates were assessed on the X-ray films. Device-related complications, including ABL, subsidence, radiographic adjacent segment pathology, and heterotopic ossification, were recorded. Univariate analysis was used to analyze the related factors, and logistic regression analysis was used to screen the influence factors. Patients were grouped according to whether ABL occurred after operation, and the differences in clinical and imaging evaluation parameters were compared. Results There were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. Univariate analysis showed the significant differences in age, body mass index (BMI), and intraoperative blood loss between the two groups ( P<0.05). However, there was no significant difference in gender, bone mineral density (T value), preoperative blood calcium level, preoperative blood phosphorus level, preoperative alkaline phosphatase level, operative segment, operative time, and follow-up time between the two groups ( P>0.05). Multivariate analysis showed that the age and BMI were influence factors for ABL after CDA ( P<0.05). The JOA score, NDI, and VAS score significantly improved in both groups at 3 months after operation ( P<0.05), and the scores were further improved at last follow-up ( P<0.05). There was no significant difference in JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). The preoperative cervical lordosis was significantly smaller in the ABL group than in the non-ABL group ( t=-2.402, P=0.018). At last follow-up, the segmental ROM was significantly greater in the ABL group than in the non-ABL group ( P<0.05), and the lengths of the upper and lower endplates were less in the ABL group than in the non-ABL group ( P<0.05). No significant difference in the other radiographic parameters between the two groups were found ( P>0.05). Prosthesis subsidence occurred in 5 cases (3.2%), including 3 cases in the ABL group and 2 cases in the non-ABL group; the difference between the two groups was not significant ( P=1.000). Heterotopic ossification occurred in 67 cases (43.2%), including 32 cases in the ABL group and 35 cases in the non-ABL group; the difference between the two groups was significant ( χ 2=8.208, P=0.004). High-grade heterotopic ossification was detected in 26 cases (13 cases in the ABL group and 13 cases in the non-ABL group). Twenty-nine cases (18.7%) had radiographic adjacent segment pathology, including 15 cases in the ABL group and 14 cases in non-ABL group; the difference between the two groups was not significant ( χ 2=1.190, P=0.276). Conclusion The incidence of ABL after CDA was relatively high, which mainly occurred within 3 months after operation, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent influence factors for ABL. ABL does not affect the clinical outcomes but may preserve more ROM of prostheses.
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Affiliation(s)
- Tingkui Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Beiyu Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chen Ding
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yang Meng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Rong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hua Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yi Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ying Hong
- West China School of Nursing, Sichuan University/Department of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kangkang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Junbo He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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