Becker's Spine Review

6 SPINE Cervical disc replacement on the rise, ACDF leveling out: A 10-year review By Carly Behm C ervical disc replacement has increased significantly from 2011 and 2021 while anterior cervical discectomy and fusion plateaued, according to a study published Feb. 24 in e Spine Journal. Four things to know: 1. Researchers used the PearlDiver database to analyze patient demographics, complications and revisions for ACDF and cervical disc replacements between 2011 to 2021. More than 404,000 ACDF and more than 29,000 cervical disc replacement patients were included. 2. Cervical disc replacements rose by 654.24% between 2011 to 2019 but plateaued. ACDF saw a smaller uptick of 25.25% in the same time and also plateaued. 3. ACDF and cervical disc replacements had overall complication rates of 12.20% and 8.77%, respectively. e most common complications were subsequent anterior revision and dysphagia. ACDFs, especially those who had multilevel procedures, tended to have more complications and higher revision rates than cervical disc replacements. 4. e study concluded, "Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile." n Surgeons warn of 'overutilization' of spinal fusion By Carly Behm S pinal fusions are a common option for addressing back pain and spine conditions. But some spine surgeons worry that the procedure could be overdone. Although spine surgeons went to medical school to learn operative treatment, sometimes it might be better to find options to avoid surgery. "One potentially dangerous trend in spine and orthopedics is the overutilization of certain surgical procedures, such as spinal fusion, which may not always be necessary or beneficial for patients," said Ernest Braxton, MD, of Vail (Colo.) Summit Orthopaedics and Neurosurgery. "Overutilization can lead to unnecessary risks, complications and healthcare costs. is trend can be exacerbated by the concept of moral hazard, where the availability of insurance coverage or financial incentives may influence surgeons to recommend or perform surgeries that may not be medically necessary." Unnecessary spinal surgeries, which are defined as any surgical intervention that is either not needed, not indicated, or not in the patient's best interest, have grown with estimated 50 percent of lumbar spine surgeries deemed unnecessary. In the first year of the COVID-19 pandemic, more than 30,000 unnecessary spine surgeries were performed, according to a report from the Lown Institute. For spinal fusions for back pain, there were 13,541 cases performed that were considered "unnecessary." "To address this trend, there is a growing emphasis on evidence- based medicine, shared decision-making and professional guidelines among spine surgeons to ensure that surgical interventions are used judiciously and appropriately," Dr. Braxton said. "By promoting a more conservative and selective approach to surgery, spine surgeons can help mitigate the risks associated with overutilization and ensure that patients receive the most appropriate and effective care for their condition." n Yale appoints Dr. Ehud Mendel to 10-year neurosurgery professorship By Carly Behm E hud Mendel, MD, was named the Nixdorff-German Professor of Neurosurgery at Yale University in New Haven, Conn. Dr. Mendel's appointment is a 10-year term, renewable by the dean of the Yale School of Medicine, the university said in a Feb. 14 announcement. He's known for his expertise in the treatment of spine tumors. He joined Yale in 2021 as a professor of neurosurgery, and he serves as the Disease Center Director of the spine oncology program. Dr. Mendel is also division chief of spine at Yale School of Medicine and executive vice chair of neurosurgery. He earned his medical degree from Louisiana State University School of Medicine in New Orleans and completed his residency at University of Southern California Medical Center in Los Angeles. n

• Cover