Interested medical professionals can read through the full paper, as published in the Spine Journal, here.
Although the prevalence of indications and contraindications to lumbar total disc replacement (TDR) has been evaluated, no study to date has quantified the potential candidacy for cervical disc replacement in practice.
To report the potential candidacy rate for cervical TDR from both an academic and private practice spine surgery setting.
Retrospective case series.
Patient record review of 167 consecutive patients who underwent cervical spine surgery by 1 of 2 orthopedic spine surgeons between January 1, 2003 and January 1, 2005.
Evaluation of potential candidacy for cervical TDR, with emphasis on both contraindications and indications.
In this study, we used the published contraindications and indications listed in trials of four different cervical disc arthroplasty devices: ProDisc-C (Synthes Spine, West Chester, PA), PRESTIGE LP (Medtronik Sofamor Danek, Memphis, TN), Bryan Cervical Disc prosthesis (Medtronik Sofamor Danek, Memphis, TN), and Porous Coated Motion (PCM; Cervitech, Rockaway, NJ). The proportion of patients who met both inclusion and exclusion criteria was calculated. We also examined the proportion of patients who would be candidates for cervical TDR if the indications were expanded to include the treatment for adjacent segment disease (ASD).
Of the 167 patients (mean age 50.8 years, range 20-89 years) reviewed, 91.6% (153/167) had fusion surgery and 8.4% (14/167) had nonfusion surgery. Fifty-seven percent (95/167) had absolute contraindications to cervical TDR, and within this group the average number of contraindications was 2.1 (SD=1.2, range 0-5). Forty-three percent (72/167) met the strict inclusion criteria, and had no exclusion criteria. If the indications were expanded to include treatment for ASD, an additional 4.2% (7/167) of the patients would have qualified as candidates for cervical TDR.
Compared with lumbar TDR, total disc replacement may have a larger potential role in the treatment of cervical degenerative conditions, as 43% of patients would have met the strict criteria for TDR candidacy, or 47% if the indications were expanded to include treatment for ASD.
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.
About Less Exposure Surgery
Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.
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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 & Citation Details
- Department of Orthopaedic Surgery, The Hospital of The University of Pennsylvania, Philadelphia PA, 19104, USA.