6:12170. Comparison of multiple level vs. single level cervical disc replacement: 178 consecutive prostheses

Object In recent years, there has been increased interest in the use of cervical disc replacement (CDR) as an alternative to anterior cervical discectomy and fusion (ACDF). While ACDF is a proven intervention for patients with myelopathy or radiculopathy, it does have inherent limitations. Cervical disc replacement was designed to preserve motion, avoid the limitations of fusion, and theoretically allow for a quicker return to activity. A number of recently published systematic reviews and randomized controlled trials have demonstrated positive clinical results for CDR, but no studies have revealed which of the 2 treatment strategies is more cost-effective. The purpose of this study was to evaluate the cost-effectiveness of CDR and ACDF by using the power of decision analysis. Additionally, the authors aimed to identify the most critical factors affecting procedural cost and effectiveness and to define thresholds for durability and function to focus and guide future research. Methods The authors created a surgical decision model for the treatment of single-level cervical disc disease with associated radiculopathy. The literature was reviewed to identify possible outcomes and their likelihood following CDR and ACDF. Health state utility factors were determined from the literature and assigned to each possible outcome, and procedural effectiveness was expressed in units of quality-adjusted life years (QALYs). Using ICD-9 procedure codes and data from the Nationwide Inpatient Sample, the authors calculated the median cost of hospitalization by multiplying hospital charges by the hospital-specific cost-to-charge ratio. Gross physician costs were determined from the mean Medicare reimbursement for each current procedural terminology (CPT) code. Uncertainty as regards both cost and effectiveness numbers was assessed using sensitivity analysis. Results In the reference case, the model assumed a 20-year duration for the CDR prosthesis. Cervical disc replacement led to higher average QALYs gained at a lower cost to society if both strategies survived for 20 years ($3042/QALY for CDR vs $8760/QALY for ACDF). Sensitivity analysis revealed that CDR needed to survive at least 9.75 years to be considered a more cost-effective strategy than ACDF. Cervical disc replacement becomes an acceptable societal strategy as the prosthesis survival time approaches 11 years and the $50,000/QALY gained willingness-to-pay threshold is crossed. Sensitivity analysis also indicated that CDR must provide a utility state of at least 0.796 to be cost-effective. Conclusions Both CDR and ACDF were shown to be cost-effective procedures in the reference case. Results of the sensitivity analysis indicated that CDR must remain functional for at least 14 years to establish greater cost-effectiveness than ACDF. Since the current literature has yet to demonstrate with certainty the actual durability and long-term functionality of CDR, future long-term studies are required to validate the present analysis.

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Biomechanical Analysis of Cervical Disc Replacement and Fusion Using Single Level, Two Level, and Hybrid Constructs

Spine ◽

10.1097/brs.0000000000001044 ◽

2015 ◽

Vol 40 (20) ◽

pp. 1578-1585 ◽

Cited By ~ 34

Author(s):

Anup A. Gandhi ◽

Swathi Kode ◽

Nicole A. DeVries ◽

Nicole M. Grosland ◽

Joseph D. Smucker ◽

...

Keyword(s):

Biomechanical Analysis ◽

Disc Replacement ◽

Cervical Disc ◽

Cervical Disc Replacement ◽

Single Level

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Single-Level Cervical Disc Replacement Using a PEEK-on-Ceramic Implant: Results of a Multicenter FDA IDE Trial With 24-Month Follow-up

The International Journal of Spine Surgery ◽

10.14444/8084 ◽

2021 ◽

pp. 8084

Author(s):

Richard D. Guyer ◽

Domagoj Coric ◽

Pierce D. Nunley ◽

Rick C. Sasso ◽

Michael Musacchio ◽

...

Keyword(s):

Disc Replacement ◽

Cervical Disc ◽

Cervical Disc Replacement ◽

Single Level ◽

Ceramic Implant

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Incidence and outcomes of anterior bone loss in single-level Prestige LP cervical disc replacement

Chinese Medical Journal ◽

10.1097/cm9.0000000000001254 ◽

2020 ◽

Vol 134 (1) ◽

pp. 109-111

Author(s):

Xiao-Fei Wang ◽

Yang Meng ◽

Hao Liu ◽

Bei-Yu Wang ◽

Ying Hong

Keyword(s):

Bone Loss ◽

Disc Replacement ◽

Cervical Disc ◽

Cervical Disc Replacement ◽

Single Level

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Artificial Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion in the Management of Single Level Cervical Disc Prolapse: Randomized Control Single Blinded Study

The Medical Journal of Cairo University ◽

10.21608/mjcu.2020.116550 ◽

2020 ◽

Vol 88 (12) ◽

pp. 1733-1742

Author(s):

MOHAMED ELMALLAWANY, M.D.; HESHAM EDWAL, M.Sc. ◽

MOHAMMED A. SAWAN, M.D.; MOHAMED A. THABET, M.D.

Keyword(s):

Anterior Cervical Discectomy ◽

Disc Replacement ◽

Cervical Disc ◽

Disc Prolapse ◽

Cervical Discectomy ◽

Cervical Disc Replacement ◽

Single Level ◽

Blinded Study ◽

Randomized Control

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161. Cervical disc replacement using a PEEK-on-ceramic implant: prospective data from seven sites participating in an FDA IDE trial for single-level surgery

The Spine Journal ◽

10.1016/j.spinee.2020.05.572 ◽

2020 ◽

Vol 20 (9) ◽

pp. S80

Author(s):

Domagoj Coric ◽

Richard D. Guyer ◽

Cameron N. Carmody ◽

Rick C. Sasso ◽

Michael J. Musacchio ◽

...

Keyword(s):

Disc Replacement ◽

Cervical Disc ◽

Prospective Data ◽

Cervical Disc Replacement ◽

Single Level ◽

Ceramic Implant

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Cervical disc replacement: examining “real-world” utilization of an emerging technology

Journal of Neurosurgery Spine ◽

10.3171/2019.10.spine19919 ◽

2020 ◽

Vol 32 (5) ◽

pp. 689-695

Author(s):

Christopher D. Witiw ◽

Fabrice Smieliauskas ◽

Sandra A. Ham ◽

Vincent C. Traynelis

Keyword(s):

Real World ◽

Private Insurance ◽

National Level ◽

Cervical Radiculopathy ◽

Disc Replacement ◽

Cervical Disc ◽

Charlson Comorbidity Index Score ◽

Cervical Disc Replacement ◽

Single Level ◽

South Central

OBJECTIVECervical disc replacement (CDR) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylotic pathology. While much is known about the efficacy of CDR within the constraints of a well-controlled, experimental setting, little is known about general utilization. The authors present an analysis of temporal and geographic trends in “real-world” utilization of CDR among those enrolled in private insurance plans in the US.METHODSEligible subjects were identified from the IBM MarketScan Databases between 2009 and 2017. Individuals 18 years and older, undergoing a single-level CDR or ACDF for cervical radiculopathy and/or myelopathy, were identified. US Census divisions were used to classify the region where surgery was performed. Two-level mixed-effects regression modeling was used to study regional differences in proportional utilization of CDR, while controlling for confounding by regional case-mix differences.RESULTSA total of 47,387 subjects met the inclusion criteria; 3553 underwent CDR and 43,834 underwent ACDF. At a national level, the utilization of single-level CDR rose from 5.6 cases for every 100 ACDFs performed in 2009 to 28.8 cases per 100 ACDFs in 2017. The most substantial increases occurred from 2013 onward. The region of highest utilization was the Mountain region (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming), where 14.3 CDRs were performed for every 100 ACDFs (averaged over the 9-year period of study). This is in contrast to the East South Central region (Alabama, Kentucky, Mississippi, and Tennessee), where only 2.1 CDRs were performed for every 100 ACDFs. Patient factors that significantly increased the odds of undergoing a CDR were age younger than 40 years (OR 15.9 [95% CI 10.0–25.5]; p < 0.001), no clinical evidence of myelopathy/myeloradiculopathy (OR 1.5 [95% CI 1.4–1.7]; p < 0.001), and a Charlson Comorbidity Index score of 0 (OR 2.7 [95% CI 1.7–4.2]; p < 0.001). After controlling for these factors, significant differences in utilization rates remained between regions (chi-square test = 830.4; p < 0.001).CONCLUSIONSThis US national level study lends insight into the rate of uptake and geographic differences in utilization of the single-level CDR procedure. Further study will be needed to ascertain specific factors that predict adoption of this technology to explain observed geographic discrepancies.

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Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Neurosurgical FOCUS ◽

10.3171/2016.11.focus16407 ◽

2017 ◽

Vol 42 (2) ◽

pp. E6 ◽

Cited By ~ 15

Author(s):

Niketh Bhashyam ◽

Rafael De la Garza Ramos ◽

Jonathan Nakhla ◽

Rani Nasser ◽

Ajit Jada ◽

...

Keyword(s):

Readmission Rate ◽

Anterior Cervical Discectomy ◽

Disc Replacement ◽

Independent Effect ◽

Cervical Disc ◽

Cervical Discectomy ◽

Cervical Disc Replacement ◽

Single Level ◽

History Of ◽

Reoperation Rates

OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) versus those after cervical disc replacement (CDR). METHODS The authors used the 2013–2014 American College of Surgeons National Surgical Quality Improvement Program database. Included were adult patients who underwent first-time single-level ACDF or CDR for cervical spondylosis or disc herniation. Primary outcome measures were readmission and/or reoperation within 30 days of the original surgery. Logistic regression analysis was used to assess the independent effect of the procedure (ACDF or CDR) on outcome, and results are presented as odds ratios with 95% confidence intervals. RESULTS A total of 6077 patients met the inclusion criteria; 5590 (92.0%) patients underwent single-level ACDF, and 487 (8.0%) patients underwent CDR. The readmission rates were 2.6% for ACDF and 0.4% for CDR (p = 0.003). When stratified according to age groups, only patients between the ages of 41 and 60 years who underwent ACDF had a significantly higher readmission rate than those who underwent CDR (2.5% vs 0.7%, respectively; p = 0.028). After controlling for patient age, sex, body mass index, smoking status, history of chronic obstructive pulmonary disease (COPD), diabetes, hypertension, steroid use, and American Society of Anesthesiologists (ASA) class, patients who underwent CDR were significantly less likely to undergo readmission within 30 days than patients who underwent ACDF (OR 0.23 [95% CI 0.06–0.95]; p = 0.041). Patients with a history of COPD (OR 1.97 [95% CI 1.08–3.57]; p = 0.026) or hypertension (OR 1.62 [95% CI 1.10–2.38]; p = 0.013) and those at ASA Class IV (OR 14.6 [95% CI 1.69–125.75]; p = 0.015) were significantly more likely to require readmission within 30 days. The reoperation rates were 1.2% for ACDF and 0.4% for CDR (p = 0.086), and multivariate analysis revealed that CDR was not associated with lower odds of reoperation (OR 0.60 [95% CI 0.14–2.55]; p = 0.492). However, increasing age was associated with a higher risk (OR 1.02 [95% CI 1.00–1.05]; p = 0.031) of reoperation; a 2% increase in risk per year of age was found. CONCLUSIONS Patients who underwent single-level ACDF had a higher readmission rate than those who underwent single-level CDR in this study. When stratified according to age, this effect was seen only in the 41- to 60-year age group. No significant difference in the 30-day single-level ACDF and single-level CDR reoperation rates was found. Although patients in the ACDF group were older and sicker, other unmeasured covariates might have accounted for the increased rate of readmission in this group, and further investigation is encouraged.

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