Considering the Cost of Cervical Fusion vs. Disc Replacement

Artificial Cervical Disc Surgery Cheaper Than Fusion

– Kevin McKeever
HealthDay
Posted: 2008-04-28 19:05:04

Note: This article was funded by ADR Manufacturer Medtronic, maker of the FDA Approved prestige Cervical Artificial Disc. The real cost of surgery is not just in the upfront expenses.

MONDAY, April 28 (HealthDay News) — Treating cervical degenerative disc disease by surgically implanting an artificial vertebrae onto one’s spine may cost more initially than a traditional disc fusion operation, but it saves the patient almost $6,000 within two years, according to a new study.

The cost savings is primarily from the patient’s ability to return to work sooner after surgery and his or her need for fewer follow-up procedures.

The study — which was funded by Medtronic, the maker of the artificial cervical disc — was expected to be presented April 29 at the annual meeting of the American Association of Neurological Surgeons, in Chicago.

More than 200,000 procedures are performed each year in the United States to relieve compression on the spinal cord or nerve roots. The most common involves spinal fusion surgery to unify two or more vertebrae in an effort to strengthen the spine and alleviate chronic neck pain.

A year ago, the U.S. Food and Drug Administration approved the use of the first, and to date only, artificial cervical disc in certain cervical spine surgeries. Medtronic’s PRESTIGE disc is a stainless-steel device with a ball-in-trough design, held in place with bone screws.

Researchers conducting a cost-benefit analysis on 541 patients who received either the artificial cervical disc (arthroplasty) or fusion surgery found arthroplasty saved the patient an average of $5,988 over two years following the surgery.

The cost of initial surgery, secondary procedures and medical devices per patient and the average initial procedure cost were both higher for arthroplasty patients than for fusion patients; however, the artificial disc recipients saved long-term, because they needed fewer secondary procedures and returned to work following surgery an average of 38 days sooner than fusion patients.

The return to work alone yielded a gain in work productivity of $6,368, the report said.

“From a societal perspective, the economic benefits associated with these outcomes may offset the increased device costs associated with arthroplasty therapy,” said study presenter Dr. Vincent C. Traynelis, of the University of Iowa, in a prepared statement.

Which Plastic Water Bottles are Safest?

Choose your water bottles very carefully in order to prevent chemicals in the plastic from leaching into your water.

Plastic water bottles are very convenient for carting water around when we are on the go, as they don’t break if we drop them. However, it is worth paying attention to the type of plastic your water bottle is made of, to ensure that the chemicals in the plastic do not leach into the water. If you taste plastic, you are drinking it, so get yourself another bottle.

To be certain that you are choosing a bottle that does not leach, check the recycling symbol on your bottle. If it is a #2 HDPE (high density polyethylene), or a #4 LDPE (low density polyethylene), or a #5 PP (polypropylene), your bottle is fine. The type of plastic bottle in which water is usually sold is usually a #1, and is only recommended for one time use. Do not refill it. Better to use a reusable water bottle, and fill it with your own filtered water from home and keep these single-use bottles out of the landfill.

Unfortunately, those fabulous colourful hard plastic lexan bottles made with polycarbonate plastics and identified by the #7 recycling symbol, may leach BPA. Bisphenol A is a xenoestrogen, a known endocrine disruptor, meaning it disturbs the hormonal messaging in our bodies. Synthetic xenoestrogens are linked to breast cancer and uterine cancer in women, decreased testosterone levels in men, and are particularly devastating to babies and young children. BPA has even been linked to insulin resistance and Type 2 Diabetes. For more of the science on the effects of BPA on our endocrine system etc. Nalgene, the company that manufactures the lexan water bottles also makes #2 HDPE bottles in the same sizes and shapes, so we have a viable alternative.

Unfortunately, most plastic baby bottles and drinking cups are made with plastics containing Bisphenol A. In 2006 Europe banned all products made for children under age 3 containing BPA, and as of Dec. 2006 the city of San Franscisco followed suit. In March 2007 a billion-dollar class action suit was commenced against Gerber, Playtex, Evenflo, Avent, and Dr. Brown’s in Los Angeles superior court for harm done to babies caused by drinking out of baby bottles and sippy cups containing BPA. So, to be certain that your baby is not exposed, use glass bottles.

Check the recycling numbers on all your plastic food containers as well, and gradually move to storing all food in glass or ceramic.

Store water in glass or brass if possible, and out of direct sunlight.

Source: http://trusted.md/blog/vreni_gurd/2007/03/29/plastic_water_bottles

Motion Preservation Surgery of the Spine: Advanced Techniques and Controversies: Expert Consult: Online and Print

Motion Preservation Surgery Text Book

by James J. Yue (Author), Rudolph Bertagnoli (Author), Paul C. McAfee (Author), Howard S. An (Author)

Book Link: Motion Preservation Surgery

This is the most authoritative text available at the time of this writing (August 2008).

* Publisher: Elsevier Health Sciences
* Pub. Date: June 2008

Product Description

New motion-preserving devices are revolutionizing spine surgery but the learning curve for these operations is steep, and great attention must be given to patient and device selection and the perfect execution of each procedure. Only one reference spells out exactly how to perform these new techniques and its peerless author team, comprised of key investigators involved in the devices’ actual clinical trials, is uniquely qualified to help you get the best results! These global leaders in this area discuss the advantages and disadvantages of the full range of non-fusion technologies and present the step-by-step, richly illustrated operative guidance you need to achieve optimal outcomes! 3 hours of surgical video on DVD demonstrate how to perform key procedures, and access to the complete contents of the book online enables you to reference it conveniently from any computer.

* Select the best device and approach for each patient!
* cervical total disc arthroplasty
* lumbar total disc arthroplasty
* lumbar partial disc replacement: nucleus replacement
* lumbar posterior dynamic stabilization: pedicle screw based
* lumbar posterior dynamic stabilization: interspinous based
* lumbar facet replacement
* Produce optimal outcomes with detailed advice on
* advantages and disadvantages of each option
* indications and contraindications
* patient selection
* interpretation of imaging studies
* surgical anatomy and biomechanics
* surgical techniques
* tips and pearls
* See how to perform each technique, thanks to
* step-by-step, full-color illustrations
* more than 3 hours of surgical videos on DVD, narrated by the experts!
* Access to the complete contents of the book online lets you perform rapid searches, follow links to Medline and PubMed abstracts, and more.

Heterotopic Ossification in Total Cervical Artificial Disc Replacement.

Cervical Spine
Spine. 31(24):2802-2806, November 15, 2006.
Mehren, Christoph MD *; Suchomel, Petr MD, PhD +; Grochulla, Frank MD *; Barsa, Pavel MD +; Sourkova, Petra MD +; Hradil, Jan MD +; Korge, Andreas MD *; Mayer, H Michael MD, PhD *

Abstract:
Study Design. Prospective clinical study enrolled in 2 centers (Munich and Liberec) as part of a prospective European multicenter study with ProDisc C (Synthes Inc., Paoli, PA).

Objectives. The first goal of the study was to evaluate the rate of heterotopic ossifications identified with plain radiograph following total cervical disc replacement (TCDR). The second goal was to show whether segmental motion can be preserved, and whether TCDR can provide improvement of the patient’s ability to perform activities of daily living as well as a decrease of pain.

Summary of Background Data. Only a few reports about the radiologic outcome after TCDR are published so far. Heterotopic ossification is a well-known phenomenon after total hip arthroplasty. The rate of heterotopic ossification following TCDR is unclear.

Methods. The radiographs of 54 patients (in total, 77 implanted prostheses) were analyzed 1 year after TCDR with a ProDisc C prosthesis. We classified the heterotopic ossification in 5 grades according to a recently published classification system for lumbar total disc replacement. For clinical parameters, the visual analog scale and the Neck Disability Index were evaluated preoperatively and 1 year postoperatively. The Student t test and Wilcoxon test were used for statistical analysis.

Results. In 26 treated segments (33.8%), no heterotopic ossification was detectable. Grade 1 ossifications were present in 6 levels (7.8%). A total of 30 segments (39.0%) showed grade 2 ossifications. Heterotopic ossifications that led to restrictions of the range of motion were present in 8 cases (10.4%). One year postoperatively, 7 cases (9.1%) had a spontaneous fusion of the treated segment. The clinical parameters improved significantly and were similar to previous reports about TCDR.

Conclusions. Only 33.8% of the patients did not show any signs of heterotopic ossification, and the rate of spontaneous fusion after TCDR 1 year after surgery was unexpectedly high. There were 49.4% of the patients with grade 2-3 ossification, which lets us suspect an even higher rate of spontaneous fusion after long-term follow-ups. Motion preservation after TCDR is only guaranteed if spontaneous fusion can be prevented. Thus, mobility of the implanted segments needs to be further studied.

(C) 2006 Lippincott Williams & Wilkins, Inc.

Magnetic Resonance Imaging Clarity of the Bryan(R), Prodisc-C(R), Prestige LP(R), and PCM(R) Cervical Arthroplasty Devices.

Diagnostics
Spine. 32(6):673-680, March 15, 2007.
Sekhon, Lali H. S. MBBS, PhD, FRACS *; Duggal, Neil MD, FRCS(C) +; Lynch, James J. MD, FRSC I *; Haid, Regis W. MD ++; Heller, John G. MD [S]; Riew, K Daniel MD [//]; Seex, Kevin MBBS, FRACS, FRCS [P]; Anderson, Paul A. MD **

Abstract:
Study Design. Prospective, randomized, controlled and double-blinded study on imaging of artificial discs.

Objective. The purpose of this study is to compare postoperative imaging characteristics of the 4 currently available cervical arthroplasty devices at the level of implantation and at adjacent levels.

Summary of Background Data. Cervical arthroplasty is being performed increasingly frequently for degenerative disc disease and, in most cases, with frank neural compression. Unlike lumbar arthroplasty, performed mainly for axial back pain, decompression of neural elements may need to be confirmed with postoperative imaging after cervical arthroplasty.

Methods. Preoperative and postoperative magnetic resonance imaging scans of 20 patients who had undergone cervical arthroplasty were assessed for imaging quality. Five cases each of the Bryan(R) (Medtronic Sofamor Danek, Memphis, TN), Prodisc-C(R) (Synthes Spine, Paoli, PA), Prestige LP(R) (Medtronic Sofamor Danek), and PCM(R) devices (Cervitech, Rockaway, NJ) were analyzed. Six blinded spinal surgeons scored twice sagittal and axial T2-weighted images using the Jarvik 4-point scale. Statistical analysis was performed comparing quality before surgery and after disc implantation at the operated and adjacent levels and between implant types.

Results. Moderate intraobserver and interobserver reliability was noted. Preoperative images of patients in all implant groups had high-quality images at operative and adjacent levels. The Bryan(R) and Prestige LP(R) devices allowed satisfactory visualization of the canal, exit foramina, cord, and adjacent levels after arthroplasty. Visualization was significantly impaired in all PCM(R) and Prodisc-C(R) cases at the operated level in both the spinal canal and neural foramina. At the adjacent levels, image quality was statistically poorer in the PCM(R) and Prodisc-C(R) than those of Prestige LP(R) or Bryan(R).

Conclusions. Postoperative visualization of neural structures and adjacent levels after cervical arthroplasty is variable among current available devices. Devices containing nontitanium metals (cobalt-chrome-molybdenum alloys in the PCM(R) and Prodisc-C(R)) prevent accurate postoperative assessment with magnetic resonance imaging at the surgical and adjacent levels. Titanium devices, with or without polyethylene (Bryan(R) disc or Prestige LP(R)), allow for satisfactory monitoring of the adjacent and operated levels. This information is crucial for any surgeon who wishes to assess adequacy of neural decompression and where monitoring of adjacent levels is desired.

(C) 2007 Lippincott Williams & Wilkins, Inc.

Multiple-Level Arthroplasty With PCM Disc May Be as Effective as Single-Level Replacement

Note: This article was originally published in 2005, and is based on a Study done in Brazil. The device used was the PCM from Cervitech.

April 20, 2005 (New Orleans) — With two-year follow-up data on just under 100 patients, it appears that multiple-level arthroplasty with the Porous Coated Motion (PCM) cervical disc is as effective at reducing pain and preserving spine function as single-level arthroplasty with the device, the lead investigator reports.

Luiz Pimenta, MD, a neurosurgeon at the Clinica Mattos Pimenta in Sao Paolo, Brazil, presented the data here at the American Association of Neurological Surgeons annual meeting on behalf of the multiple centers participating in the PCM study. Dr. Pimenta has served as a consultant to PCM’s developer and manufacturer, Cervitech, Inc.

That company is based in the U.K. and the U.S., with headquarters in Rockaway, New Jersey.

According to Cervitech, the PCM disc is designed to allow “translational motion in an arc consistent with the natural motion of the cervical spine segment.” The disc has an ultra-high molecular weight polyethylene bearing surface attached to the lower endplate. Both of the endplates are made of cobalt chrome.

In the trial presented by Dr. Pimenta, 41 patients had a single-level replacement, 34 patients had a two-level replacement, eight had three-level replacement, and four had four-level replacement.

For single-level replacement patients, mean scores for the neck disability index (NDI) and the visual analog scale (VAS) score decreased by 38.7% and 38.6%, respectively, compared with 65% and 61.4% for the bilevel group. For the multiple-level replacement patients, the NDI decreased by 95.3% and the VAS by 86.6%.

Dr. Pimenta also reported on Odom scores at two years. Almost 13% of single-level replacement patients had excellent Odom scores compared with 16.3% of bilevel patients and 20.8% of multiple-level replacement patients.

In patients with multiple-level replacements, the clinical outcomes were generally better, and range of motion was much improved also, said Dr. Pimenta. Clinical studies of single-level arthroplasty might be underestimating the true benefit of the procedure, he said, but added that a large-scale randomized study was necessary.

Edward Benzel, MD, director of spinal disorders at the Cleveland Clinic Foundation in Ohio, said it appeared that the PCM disc is helping to establish and maintain lordosis. Fusion, he said, is well known for leading to decreased range of motion and degenerative changes at adjacent levels.

With the PCM disc study, it seemed that restoration of sagittal alignment was a key to the success seen with the multiple-level replacement patients, Dr. Benzel said. The maintenance of sagittal alignment may, in fact, be one of the most important variables, he said.

Total disc arthroplasty is likely to be much more costly than fusion, but “if there is greater quality, we may be willing to accept a greater cost,” Dr. Benzel said. He called the PCM disc study a “seminal work.” I am republishing here because it is one of the few articles explaining the potential benefits of Cervical ADR at multiple levels.

AANS 2005 Annual Meeting: Abstract 755. April 19, 2005.

Reviewed by Gary D. Vogin, MD

How Soft Drinks (Soda Pop) Destroys Your Health

Soft Drinks are Damaging to Your Health

Most people realize that consumption of soft drinks is not healthy, but just how unhealthy often catches them by surprise.

Soft Drinks impact your health by:

• Causing Obesity though the consumption of “Empty Calories”
• Wear down bones contributing to Osteoporosis
• Cause Tooth Decay and Erosion
• Contribute to Heart Disease
• Contribute to the development of Kidney Stones
• Contain potential carcinogens
• When combined with Artificial Sweeteners contribute to Neurological Disorders

The bottom line is every time you consume Carbonated Beverages - Soft Drinks - Soda Pop you are doing your body a disservice.

If you would like to know more please take the time to read this report by Michael F. Jacobson, Ph.D. from the Center for Science in the Public Interest, Washington, D.C.

This is a PDF file and requires Acrobat or other PDF reader.

Report Link: Liquid Candy - How Soft Drinks Are Harming Americans’ Health

Dangers of Relying Solely on X-Ray for Diagnosis of Cervical Disc Problems

Case Report Acute Cervical Disc Lesions

A 6′6″ tall basketball playing student was involved in a fracas with gate crashers at his sister’s birthday party and was severely beaten up by six soldiers. He subsequently suffered neck and arm pain and was seen at a hospital on several occasions and told that because his pain neck x-rays were normal there was no dramatic lesion. He presented two years later unable to continue playing basketball because of an insidiously evil and spastic paraparesis and evidence of bilateral C7 root lesions.

Myelography revealed a severe traumatic C6/7 disc lesion which required surgery. The root pain was relieved, but recovery from the cord damage was incomplete. This case exemplifies once again the dangers of accepting that normal x-rays indicate there is no abnormality.

Where a neck injury occurs in a patient who already has an abnormal neck due to cervical spondylosis. In such patients sudden flexion or extension of the neck following a simple trip or rear end collision in a car they produce acute root symptoms or even a cute cord damage. Usually the root symptoms are bilateral may affect multiple routes and the accompanying cord damage may cause an acute tetraparesis. The potential seriousness of even minor traumatic events affecting the cervical spine in this way in patients with severe pre-existing spondylosis must be recognized.

Source: Neurological Differential Diagnosis By John Patten

Video: Lumbar Spinal Fusion for Fracture

Actual Lumbar Spinal Fusion

Although the background of this patient is not revealed in the Video it is clearly a trauma as there is discussion of a fracture and whether the patient will regain use of his legs. I am showing this video so those who have not seen spinal surgery can get a “feel” for just how it’s done and the tools that are used. Warning to those with a weak stomach; this is very graphic. Note the use of force and the instruments used to place the rods and bone grafts.

Screening for Prostate Cancer Not Recommended for Elderly Men

NEW YORK - Doctors should stop routine prostate cancer screening of men over age 75 because there is more evidence of harm than benefit, a federal task force advised on a hotly debated topic.

The U.S. Preventive Services, which made the recommendation Monday, reported finding evidence that the benefits of treatment based on routine screening of this age group “are small to none.” However, treatment often causes “moderate-to-substantial harms,” including erectile dysfunction and bladder control and bowel problems, the task force said.

The new guidance is the first update by the task force on prostate cancer screening since 2002. Its last report concluded there was insufficient evidence to recommend prostate screening for men of all ages.

In recent years, there has been a growing debate about the value of the somewhat imprecise PSA blood test to detect cancer, as well as the value of treating most prostate cancers. A positive result from the test must be confirmed by a biopsy. And even then, there is no foolproof method of identifying aggressive tumors from slow-growing ones. A number of experts contend patients are being over treated.

“The issue of screening for is frankly an area of medicine that remains somewhat unsettled,” said Dr. Durado Brooks, a prostate cancer specialist for the American Cancer Society. “While it’s clear there is benefit to a significant number of men, it’s equally clear that many men end up being diagnosed and treated for cancers that would likely not have caused them any significant harm.”

Most major U.S. medical groups recommend doctors discuss the potential benefits and known harms of prostate screening with their patients and make individual decisions. And most agree such testing shouldn’t occur before age 50.

The federal task force, which sets the nation’s primary care standards, reviewed past research in reaching its conclusion and “could not find adequate proof that early detection leads to fewer men dying of the disease,” task force chairman Dr. Ned Calonge of Denver said in a statement.

The cancer society’s advice for screening differs from the task force’s because it doesn’t set a fixed age to stop screening, Brooks said. It suggests that men shouldn’t be offered screening if they aren’t expected to live another 10 years.

“That’s because every 75-year-old is not created equal,” said Brooks.

While some have health problems and aren’t likely to live long, others are “very active, very vigorous and have minimal health issues, and many of those men are going to live into their late 80s or 90s,” Brooks said.

Prostate cancer is the most common cancer in American men — about 220,000 cases will be diagnosed this year. It is the second leading cause of cancer deaths in men. But most tumors grow so slowly they never threaten lives.

Earlier this year, a study found that older men who already had early-stage prostate cancer were not taking a big risk by not treating it right away. The vast majority were alive 10 years later without significantly worrying symptoms or had died of other causes.

Prostate cancer treatments are tough, especially on older men. Some doctors instead recommend “watchful waiting” to monitor signs of the disease and treat only if they worsen, but smaller studies give conflicting views of the safety of that approach.

The new guidelines from the Preventive Services were published in this month’s Annals of Internal Medicine.

http://www.annals.org/content/vol149/issue3/