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.
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.
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
Artificial Disc Replacement Lumbar Spine Surgical Outcome
Anyone with Back Pain has been told “Surgery is the last resort”. Most people do not require surgery and should not have surgery until every possible conservative treatment has been exhausted. However for those cases that do warrant surgery there is a new alternative to the current “Fusion” methods.
The alternative is Artificial Disc Replacement. While in it’s infancy in the USA, these procedures have been taking place outside of the USA for more than a decade.
This story presents one such patient who after years of suffering and failed procedures was given her life back following Artificial Disc Replacement Surgery.
