Becker's Spine Review

6 SPINE 1.26% of lumbar disc replacements needed revisions, Texas Back Institute surgeons find By Carly Behm O ver 20 years, only 1.26% of lumbar disc replacements have needed a follow-up revision surgery or removal, spine surgeons at Texas Back Institute found. eir research, published in the May 15 issue of Spine, looked at data from 2,141 lumbar disc replacements since 2000. Of the total patients, disc removal was done in 24 patients, and 12 patients needed revisions. About 40% of removals and revisions happened in the first 25 total disc replacement cases done by individual surgeons. ere was also a patient who had a "significant vascular complication" that was removed aer trauma. Scott Blumenthal, MD, one of the investigators on the study, told Becker's that the study addresses the worry that lumbar disc replacement through the anterior approach could be dangerous. "People were concerned when the technology first came out and they still use it to kind of create 'fake news' that these things come out and they need to be revised," Dr. Blumenthal said. "is is really the first paper that gives a numerator and a denominator in a large series. e perspective is number one, the removal and revision rate is quite low, and so that counteracts that discussion or that criticism. And it compares favorably to the hip and knee literature, which shows 5% to 10% revision rates over that same time period … at's the big take home message — it compares favorably to hip and knee replacements, and it's very infrequent." Richard Guyer, MD; Jessica Shellock, MD; Jack Zigler, MD, and Donna Ohnmeiss, PhD, all part of TBI, are all listed as study investigators. Dr. Blumenthal said he and his colleagues also examined revision rates in cervical disc replacements for a paper that was recently submitted for publication. In that study, they found the revision rate was about 1.4%. n 2 CMS spine proposals to know By Carly Behm C MS is proposing two new developments in spine- related coding and payments, the International Society for the Advancement of Spine Surgery said April 17. CMS is proposing eight new MS-DRGs to delineate single and multilevel lumbar fusions, according to a news release. These are expected to better track resource utilization for specific procedures and adjust hospital payments for resources behind multilevel fusions. The other proposal is looking into an episode-based alternative payment model called the Transforming Episode Accountability Model. The TEAM model is expected to go into effect at the start of 2026. Participating hospitals will use it to manage total costs of care for spinal fusions and compare them to target CMS costs over four years. CMS also released a new set of diagnostic codes to specifically describe intervertebral disc degeneration with discogenic pain. Those will take effect Oct. 1. n Vanderbilt adopts ERAS program for spine By Carly Behm N ashville-based Vanderbilt University Medical Center launched an enhanced recovery after surgery pathway for spine patients at Vanderbilt University Hospital and Belle Meade Surgery Center. The Nashville-based surgery center will add protocols to help patients recover faster, leave the facility sooner and have fewer side effects from pain management, according to an April 16 news release. The ERAS program was developed by the Department of Neurological Surgery, the Division of Spine Surgery and the Department of Anesthesiology. The spine ERAS pathway team includes Scott Zuckerman, MD, Julian Lugo-Pico, MD, and Raymond Gardocki, MD. VUMC began implementing ERAS in 2024 for other specialities including colorectal surgery, gynecological surgery, C-section, hip/femur fractures, cystectomy, surgical weight loss, complex hernia repair and total joint replacement. n

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