1. Cervical disc arthroplasty safe and effective. A study conducted by neurosurgeons at University of California, San Francisco found that cervical disc arthroplasty is a safe treatment option and may be the better treatment option for patients under the age of 50. During the procedure, a herniated disc is removed and replaced with an artificial disc usually made from steel, plastic or titanium. Anterior cervical discectomy and fusion is still a viable treatment option, but the artificial disc places less stress on adjacent discs, which decreases the risk of developing adjacent disc disease.
The study, which was conducted at hospitals around the country, examined 1,213 patients with cervical disc disease, 621 of which received an artificial disc. After the two- year follow-up, patients in both groups had good results but the rate of repeat surgery was lower among the arthroplasty patients.
2. Technology is making two-level disc replacement possible. Rick Delamarter, MD, vice chair for spine services and co-medical director of the Spine Center at Cedars-Sinai Medical Center in Los Angeles, recently led an FDA study comparing the results of fusion two-level disc replacement using the ProDisc-L. The patients who underwent total disc replacement reported quicker operations, less blood lost and faster recovery than the fusion patients. Artificial discs may also have the ability to maintain the natural spine movement to reduce the risk of revision surgery.
Both fusion and arthroplasty patients experienced less pain and reduced medication two years after surgery. A total of 73 percent of the arthroplasty patients met the study's pain improvement criteria, compared with 60 percent of the fusion patients. Additionally, 19 percent of the disc arthroplasty patients were using narcotics after two years, compared with 40 percent of the fusion patients.
3. It can be performed in an ASC. One-level cervical and lumbar artificial disc replacements can be performed in ambulatory surgery centers, and are being performed by surgeons including Kenneth Pettine, MD, a spine surgeon at Loveland (Colo.) Surgery Center. He recently conducted a study that analyzed data from 1,030 spine cases performed at the ASC from 2003-2008 and recorded benchmarks for various procedures. Patients spent an average time of 84 minutes in the OR for cervical disc replacements and 100 minutes for lumbar disc replacements at one level.
The cervical disc replacement patients spent an average of 81 minutes in the PACU while lumbar disc replacement patient spent an average of 83 minutes in the PACU. The average time patients spent in the convalescent center for one-level cervical disc replacement were 20 hours. The average time spent for one-level lumbar disc replacements was 21 hours.
4. More variation in artificial discs is needed. In order to accommodate all patients, more variation is needed in the shape and size of cervical artificial discs. According to a study published in Spine, patients of Asian decent have difficulty with current Bryan cervical artificial discs because of their unique anatomy. Researchers studied 45 patients with cervical disc herniation who received Bryan cervical disc prostheses at 51 levels. After an average of 35 months, patients showed significant improvement in neurological symptoms.
The patients reported a reduction in neck disability from 42.5 o 28.4 and the range of motion at the implant level was an average of 9.3 degrees postoperatively. No patient experienced an artificial disc migration more than 2mm.
5. Growth in the artificial disc market is expected. Over the next four years, Millennium Research Group expects to see growth in the nonfusion and artificial disc markets. Globus Medical, LDR Spine, NuVasive and SpinalMotion are poised to lead the pack in cervical and lumbar artificial discs. Spinal fusions currently contribute to approximately 95 percent of total revenues in the spine implant market, but provider cost-cutting measures and a decrease in reimbursement from payors may contribute to a decrease in revenues. In 2010, the spinal implant market experienced a 3 percent revenue decrease.
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2. Technology is making two-level disc replacement possible. Rick Delamarter, MD, vice chair for spine services and co-medical director of the Spine Center at Cedars-Sinai Medical Center in Los Angeles, recently led an FDA study comparing the results of fusion two-level disc replacement using the ProDisc-L. The patients who underwent total disc replacement reported quicker operations, less blood lost and faster recovery than the fusion patients. Artificial discs may also have the ability to maintain the natural spine movement to reduce the risk of revision surgery.
Both fusion and arthroplasty patients experienced less pain and reduced medication two years after surgery. A total of 73 percent of the arthroplasty patients met the study's pain improvement criteria, compared with 60 percent of the fusion patients. Additionally, 19 percent of the disc arthroplasty patients were using narcotics after two years, compared with 40 percent of the fusion patients.
3. It can be performed in an ASC. One-level cervical and lumbar artificial disc replacements can be performed in ambulatory surgery centers, and are being performed by surgeons including Kenneth Pettine, MD, a spine surgeon at Loveland (Colo.) Surgery Center. He recently conducted a study that analyzed data from 1,030 spine cases performed at the ASC from 2003-2008 and recorded benchmarks for various procedures. Patients spent an average time of 84 minutes in the OR for cervical disc replacements and 100 minutes for lumbar disc replacements at one level.
The cervical disc replacement patients spent an average of 81 minutes in the PACU while lumbar disc replacement patient spent an average of 83 minutes in the PACU. The average time patients spent in the convalescent center for one-level cervical disc replacement were 20 hours. The average time spent for one-level lumbar disc replacements was 21 hours.
4. More variation in artificial discs is needed. In order to accommodate all patients, more variation is needed in the shape and size of cervical artificial discs. According to a study published in Spine, patients of Asian decent have difficulty with current Bryan cervical artificial discs because of their unique anatomy. Researchers studied 45 patients with cervical disc herniation who received Bryan cervical disc prostheses at 51 levels. After an average of 35 months, patients showed significant improvement in neurological symptoms.
The patients reported a reduction in neck disability from 42.5 o 28.4 and the range of motion at the implant level was an average of 9.3 degrees postoperatively. No patient experienced an artificial disc migration more than 2mm.
5. Growth in the artificial disc market is expected. Over the next four years, Millennium Research Group expects to see growth in the nonfusion and artificial disc markets. Globus Medical, LDR Spine, NuVasive and SpinalMotion are poised to lead the pack in cervical and lumbar artificial discs. Spinal fusions currently contribute to approximately 95 percent of total revenues in the spine implant market, but provider cost-cutting measures and a decrease in reimbursement from payors may contribute to a decrease in revenues. In 2010, the spinal implant market experienced a 3 percent revenue decrease.
Related Articles on Spine Surgery:
Behavioral Graded Activity May Not be Cost-Effective for Neck Pain
5 Points on Cervical Spine Surgery
Spine Surgeons in the Summer: 4 Things to Know