Becker's Spine Review

Spine Technique & Implants 44 5-Year Spinal Disc Replacement Data is In: How it Compares With Spinal Fusion By Laura Miller A recent study of five-year data for patients who underwent cervical total disc replacement or anterior cervical discectomy and fusion show a five-fold difference in reoperation rates, according to a study published in Spine. Dr. Rick Delamarter Rick B. Delamarter, MD, of Cedars-Sinai Medical Center in Los Angeles, and Jack Zigler, MD, of Texas Back Institute in Plano, were listed as study authors. The study included 209 patients who received either total cervical disc replacement with the ProDisc-C or ACDF at 13 different treatment sites, and researchers considered a surgical intervention at any level after the initial procedure a reoperation. Here are five things to know about the results: • fter five years, patients who underwent TDR had a 97.1 percent probability of no secondary procedures, compared A with 85.5 percent for ACDF patients. Dr. Jack Zigler • o reoperations in TDR patients were due to implant breakage or device failure. N • seudarthrosis was the most common reason for reoperation at the index level among ACDF patients. P • ecurrent neck pain and/or arm pain was the most common reason for reoperation at the adjacent level for both R groups. • nly 2.9 percent of TDR patients had reoperations within five years of the initial surgery, compared with 14.5 O percent of the ACDF patients. n 8 Trends for Surgical Management of Lumbar Spinal Stenosis By Laura Miller R esearchers led by Hyun Bae, MD, a spine surgeon with Cedars-Sinai Medical Center in Los Angeles, examined patients who underwent surgery for lumbar spinal stenosis from 2004 to 2009 from the Nationwide Inpatient Sample, a database developed as part of the Healthcare Cost and Utilization Project, and the findings were published in Spine. The researchers studied patients with lumbar spinal stenosis alone, with spondylolisthesis and with scoliosis. Treatment included decompression only, simple fusion and complex fusion. The trends included: • nnual number of patients discharged inA patient with the primary diagnosis of lumbar spinal stenosis increased from 94,011 to 102,107. • ate of decompressions decreased during R that time period from 58.5 percent to 49.2 percent. • imple fusions for these patients increased S from 21.5 percent to 31.2 percent • omplex fusion rates for these patients did C not change — they remained at 6.7 percent. • one morphogenic protein use doubled B from 2004 to 2009, from 14.5 percent to 33 percent of all fusions. • nterbody device use also increased in I these patients from 28.5 percent to 45.1 percent. • ccording to the report, in 2009 26.2 perA cent of patients with lumbar spinal stenosis without instability underwent fusion procedures. • n 2009, 82.7 percent of patients with I lumbar spinal stenosis and spondylolisthesis underwent fusion and 67.6 percent of patients with lumbar spinal stenosis and scoliosis underwent fusions. n Dr. Hyun Bae

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