Interested medical professionals can read through the full paper, as published in the Spine Journal, here.
Given the experience with anterior lumbar cages, the similar enthusiasm for total disc replacement (TDR) and the economic incentives driving use of this new technology, it is important to document reasonable expectations as to the incidence of patients with appropriate indications for this new technology.
To document epidemiological data for the indications and contraindications to total disc replacement (TDR) to guide expectations for use of this new technology. STUDY DESIGN/SETTINGS: Retrospective evaluation of contraindications and indications for lumbar TDR in consecutive symptomatic patients presenting to an academic spine practice.
Six hundred twenty-seven consecutive symptomatic patients presenting to an academic spine service.
Presence of contraindications to lumbar TDR based on Food and Drug Administration criteria.
Over a year, 627 new patients were evaluated by the only orthopedic spine surgeon on faculty at a major university. 131 underwent lumbar surgeries. Surgical patients were divided into Group 1 (57 patients who had fusions) and Group 2 (74 patients who had nonfusion surgeries). The incidence (period prevalence) and prevalence (point prevalence) of indications for and contraindications to TDR were documented.
The incidence of indications for TDR was 0.5% (3/627). The prevalence of no contraindications to TDR in the fusion Group 1 was 5% (3/57). Overall, 9% (3 fusion and 9 nonfusion) had no contraindications to TDR and the same percentage satisfied indications for TDR. However, 96% (71/74) of Group 2 patients considered themselves satisfied with laminectomies and laminotomies. The combined average number of contraindications to TDR was 2 (SD, 1.33) (range, 0-6). For Group 1, it was 3 and 1 for Group 2 (p<.5).
Despite early enthusiasm for TDR replacing fusion, there was only a 0.5% incidence of indications for TDR in the overall population and a 5% prevalence in the fusion patients, but the majority were in young patients who averaged about 38 years old. The absence of contraindications for TDR did not equate to indications for TDR because other nonfusion techniques exist. Based on the history of the introduction of other new spinal technologies and the fact that the current criteria for TDR seems to result in a relatively small number of eligible patients, there is risk of overuse of this new technology.
About Author Dr. Kingsley R. Chin
Dr. Kingsley R. Chin is a board-certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology experience. He sees a niche opportunity where medicine, business and information technology meet and is uniquely experienced at the intersection of these three professions. He currently serves as Professor of Clinical and Biomedical Sciences at the Charles E. Schmidt School of Medicine at Florida Atlantic University and Professor of Clinical Orthopaedic Surgery at the Herbert Wertheim College of Medicine at Florida International University and has experience as Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School and Visiting Professor at the University of the West Indies.
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The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.
Scientific Paper Author and Citation Details
- 1. Department of Orthopaedics, Spine Surgery Service, 2 Silverstein, 3400 Spruce Street, University of Pennsylvania, Philadelphia, PA 19104, USA. firstname.lastname@example.org