Becker's Spine Review

15 SPINE SURGEONS approach to treating cervical neck pain and radiculopa- thy/myelopathy, it will become a more accessible alterna- tive to fusion. In the next five to 10 years, I predict about 50 percent to 60 percent of anterior cervical surgeries will be arthroplasty. Multilevel surgeries will also become more prevalent, amongst surgeries. ere will be a demand in the U.S. for reliable outcomes data in two- and three-level arthroplas- ty. Some surgeons are already performing them, and are reporting some outcomes, but I still think reliable data will more fully support the practice. Lastly, the hybrid construct, an oen-overlooked and sidelined technique, combining both fusion and arthro- plasty in the same patient at different levels, will also be- come more frequent. is is an excellent way to treat levels that are different time points in degenerative progression. ere is already a growing body of peer-reviewed research, and it would be beneficial for additional studies to be done to flesh out its roles in cervical spine surgery. It is the sur- geon's mandate to reduce pain and suffering. Cervical disc replacement reduces future operations, decreases opioid use and sometimes is a more effective surgery, especially in the young. In the future, arthroplasty technologies will match and perhaps surpass the reliable successes seen in other forms of joint replacement. Lali Sekhon, MD, PhD. Reno (Nev.) Orthopedic Cen- ter: I think cervical arthroplasty will continue to grow. I've been involved with cervical arthroplasty since 2000 and the original indications still stand: so disc hernia- tion, one to two levels with less than 50 percent loss of disc height for concordant radiculopathy or myelopathy, in the absence of facet disease. Correction of deformity, it's place in the aging population (average age in most [investiga- tional device exemptions] was early 40s), use for severe spondylotic disease are still issues. ere will always be a place for spinal fusion. Material choices for fusion may fill the gap between arthroplasty so that different stiffness im- plants can be used. With the plethora of devices available, it's not so much which device is used (they all work in the forgiving cervical spine), it's patient selection. Lumbar ar- throplasty may be revisited by lateral approaches. Colin Haines, MD. Virginia Spine Institute (Reston, Va.): I firmly believe that motion-preserving spinal im- plants, most notably including cervical and lumbar disc replacements, will continue to grow over the next few years. Although the indications for disc replacement are more specific than spinal fusions, more than half of my cervical surgeries are disc replacements. Because the lit- erature on cervical disc replacement is so clear, I do see more potential for growth and advancement in lumbar disc replacement. As the devices improve and data emerge on their longevity, lumbar artificial disc replacement sur- gery will become more common. However, I don't think it will ever eliminate spinal fusion surgery. Instability, sagit- tal balance mismatch and scoliosis will be better addressed with stability, which is what spinal fusions achieve. Re- gardless, the future brings great promise for artificial disc replacement with the continued evolution of this innova- tive technology. n Surgeon consensus grows around disc replacement for lumbar degenerative disc disease, study finds By Alan Condon T here is a growing consensus that lumbar total disc re- placement is a viable option for the treatment of lumbar degenerative disc disease, according to a study published in The Spine Journal. Five study details: 1. To determine risk factors for reoperation, researchers exam- ined 1,368 patients who underwent lumbar disc replacement at short-, mid- and long-term follow-up. 2. Patients who underwent primary and revision lumbar fusion and revision disc replacement were excluded from the study. 3. Reoperation occurred in 8.8 percent of patients by two years, 15.8 percent by five years and 19.5 percent by 10 years. 4. Patients with diabetes were more likely to have revision sur- gery. At 14.2 percent, lumbar fusion was the most common re- operation. 5. Teaching hospitals had a lower reoperation rate than non-teach- ing hospitals at two-year, five-year and 10-year follow-up. n Dr. Robert Watkins performs spine surgery on former 'Grey's Anatomy' star By Laura Dyrda R obert Watkins, MD, performed spine surgery on actress Katherine Heigl earlier this week, according to an ABC News report. Dr. Watkins is a partner at Watkins Spine in Marina Del Rey, Calif., and has performed surgery on several professional athletes. Ms. Heigl's surgery was performed at Marina Spine Center at Marina Del Rey Hospital, an affiliate of Cedars-Sinai in Los Angeles. In a March 18 Instagram post, Ms. Heigl said she had two titanium discs implanted into her neck. "Thank you for treating me like a human being and giving me so much of your time and attention to help me truly understand what to expect and what all my options were. Thank you for your tremendous talent and expertise for saving my neck!" she wrote to Dr. Watkins in the post. Ms. Heigl is an Emmy-winning former star of "Grey's Anatomy" who has several movie and TV credits. n

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