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Tao X, Matur AV, Street S, Shukla G, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Gibson J, Cass D, Wu A, Motley B, Cheng J, Adogwa O. No Difference in Surgical Outcomes Between Stand-Alone Devices and Anterior Plating for 1-2 Level Anterior Cervical Discectomy and Fusion: A 1:1 Exact Matched Analysis. Spine (Phila Pa 1976) 2024; 49:973-978. [PMID: 37661800 DOI: 10.1097/brs.0000000000004813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare rates of all-cause surgical and medical complications between zero-profile (ZP; stand-alone) implants versus any graft type with an anterior plate in patients undergoing 1-2 level anterior cervical discectomy and fusion (ACDF) for treatment of degenerative cervical myeloradiculopathy. SUMMARY OF BACKGROUND DATA Degenerative cervical myeloradiculopathy is increasingly prevalent in older adults. ACDF is a common surgical procedure for decompression of neural structures and stabilization and has been shown to have excellent outcomes. Although ACDFs performed with graft and plate have been the gold standard, more recently, ZP implants were developed to decrease implant-related complications, such as severe postoperative dysphagia. However, there is a paucity of papers comparing the surgical and medical complications profile of ZP (stand-alone) implants to grafts with plating systems. MATERIALS AND METHODS Data were extracted from the PearlDiver Mariner Database using Current Procedural Terminology codes to classify patients into 1 level, 2 levels, and a total of 1-2 level ACDFs. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. RESULTS 1:1 exact matching created 2 equal groups of 7284 patients who underwent 1-2 level ACDF with either grafting with a plate or ZP (stand-alone) implant. There were no statistically significant differences in all-cause surgical complications, pseudarthrosis rate, dysphagia, or need for revision surgery between both cohorts (risk ratio: 0.99, 95% CI: 0.80-1.21, P = 0.95). In addition, all-cause medical complications were similar between both cohorts (risk ratio: 1.07, 95% CI: 0.862-1.330, P = 0.573) or any specific surgical or medical complication included in this study. CONCLUSION After 1:1 exact matching, the results of this study suggest that ZP (stand-alone) implants have similar outcomes compared with grafts with plating systems, with no observed differences in all-cause surgical or medical complications profile.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Mills ES, Shelby T, Bouz GJ, Hah RJ, Wang JC, Alluri RK. A Decreasing National Trend in Lumbar Disc Arthroplasty. Global Spine J 2023; 13:2271-2277. [PMID: 35180023 PMCID: PMC10538335 DOI: 10.1177/21925682221079571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective National Database Study. OBJECTIVES The aim of this study was to investigate the national trend of lumbar disc arthroplasty (LDA) utilization from 2005 to 2017. METHODS Patients undergoing primary LDA between 2005 and 2017 were identified in the National Inpatient Sample (NIS) database. Year of the procedure, demographic, socioeconomic, hospital, and cost parameters were analyzed. The data was weighted using provided weights from the NIS database to generate national estimates of LDA procedure incidence. Lastly, we assessed the incidence of cervical disc arthroplasty (CDA) between 2005 and 2017 to serve as a historical comparison. RESULTS An estimated 20 460 patients underwent primary LDA in the United States between 2005 and 2017. There was an initial decrease in LDA procedures between 2005 and 2006 and then a plateau between 2006 and 2009. From 2010 to 2013, there was a significant year-over-year decrease in annual LDA procedures performed, followed by a second plateau from 2014 to 2017. Overall, LDA procedures decreased 82% from 2005 to 2017. Over the same time, the annual incidence of CDA utilization increased 795% from approximately 474 procedures in 2005 to 4245 procedures in 2017 (P < .01). CONCLUSIONS Lumbar disc arthroplasty utilization decreased 82% from 2005 to 2017, with a significant decrease in the rate of utilization noted after 2010. The utilization of LDA to treat selected degenerative lumbar conditions has not paralleled the increasing popularity of CDA, and, in fact, has demonstrated a nearly opposite utilization trend.
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Affiliation(s)
- Emily S. Mills
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Tara Shelby
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Gabriel J. Bouz
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Raymond J. Hah
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ram K. Alluri
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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Khalid SI, Deysher D, Thompson K, Ostrov PB, Hossa J, Mirpuri P, Adogwa O, Mehta AI. Outcomes of patients undergoing single-level arthroplasty versus anterior lumbar interbody fusion. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05616-4. [PMID: 37178246 DOI: 10.1007/s00701-023-05616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Compared to vertebral body fusion, artificial discs are thought to lessen the risks of adjacent segment disease and the need for additional surgery by maintaining spinal mobility as they mimic the intervertebral disc structure. No studies have compared the rates of postoperative complications and the requirement for secondary surgery at adjacent segments among patients who have undergone anterior lumbar interbody fusions (ALIF) versus those undergoing lumbar arthroplasty. METHODS An all-payer claims database identified 11,367 individuals who underwent single-level ALIF and lumbar arthroplasty for degenerative disc disease (DDD) between January 2010 and October 2020. Rates of complications following surgery, the need for additional lumbar surgeries, length of stay (LOS), and postoperative opioid utilization were assessed in matched cohorts based on logistic regression models. Kaplan-Meyer plots were created to model the probability of additional surgery. RESULTS Following 1:1 exact matching, 846 records of patients who had undergone ALIF or lumbar arthroplasty were analyzed. All-cause readmission within 30-30 days following surgery was significantly higher in patients undergoing ALIF versus arthroplasty (2.6% vs. 0.71%, p = 0.02). LOS was significantly lower among the patients who had undergone ALIF (1.043 ± 0.21 vs. 2.17 ± 1.7, p < .001). CONCLUSIONS ALIF and lumbar arthroplasty procedures are equally safe and effective in treating DDD. Our findings do not support that single-level fusions may biomechanically necessitate revisional surgeries.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA.
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
| | - Kyle Thompson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Philip B Ostrov
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
| | - Jessica Hossa
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
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Upfill-Brown A, Policht J, Sperry BP, Ghosh D, Shah AA, Sheppard WL, Lord E, Shamie AN, Park DY. National trends in the utilization of lumbar disc replacement for lumbar degenerative disc disease over a 10-year period, 2010 to 2019. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:343-352. [PMID: 36285102 PMCID: PMC9547699 DOI: 10.21037/jss-22-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
Background Lumbar fusion (LF) is commonly performed to manage lumbar degenerative disc disease (LDDD) that has failed conservative measures. However, lumbar disc replacement (LDR) procedures are increasingly prevalent and designed to preserve motion in carefully selected patients. Methods A retrospective cohort study was performed using the National Inpatient Sample (NIS), queried from 2010 to 2019 to identify patients undergoing single and double-level LF or LDR with a diagnosis of LDDD using International Classification of Diseases (ICD) 9th (ICD-9) and 10th (ICD-10) revision diagnostic and procedure codes. Propensity score matching (PSM) with a ratio of 2:1 was performed. All cost estimates reflect reported hospital costs adjusted to December 2019 United States Dollars. Results A total of 1,129,121 LF cases (99.3%) and 8,049 LDR cases (0.7%) were identified, with 364,637 (32.3%) and 712 (8.8%) comprising two-level surgeries, respectively. 1,712 LDRs were performed in 2010 (1.27% of all), decreasing to 565 in 2013 (0.52%), and increased slightly to 870 in 2019 (0.74%). LDR patients were significantly more likely to be younger (mean age 41.2 vs. 57.1, P<0.001) and healthier (mean ECI 0.88 vs. 1.80, P<0.001). On matched analysis, LDR hospital costs were $4,529 less (P<0.001) and length of stay was 0.65 days shorter (P<0.001) than LF patients. LDR patients had lower rates of any complication (7.0% vs. 13.2%, P<0.001), neurologic complication (3.0% vs. 4.2%, P=0.006), and blood transfusion (3.1% vs. 8.1%, P<0.001) compared to LF patients. Conclusions The prevalence of LDR procedures decreased from 2010-2017 but began to increase again in 2018 and 2019. Single-level LDR was associated with reduced costs and length of stay (LOS), and lower rates of blood transfusion compared to LF in patients with LDDD.
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Affiliation(s)
- Alexander Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Jeremy Policht
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Beau P Sperry
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Durga Ghosh
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - William L Sheppard
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Arya Nick Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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Franco D, Largoza G, Montenegro TS, Gonzalez GA, Hines K, Harrop J. Lumbar Total Disc Replacement: Current Usage. Neurosurg Clin N Am 2021; 32:511-519. [PMID: 34538477 DOI: 10.1016/j.nec.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Low back pain is the leading cause of disability worldwide in industrialized nations. The pathology underlying chronic low back pain is associated with numerous factors. Lumbar degenerative disc disease is a potential major source of low back pain. There are numerous treatment modalities and options. Nonsurgical treatment options exist in the form of pain management through a combination of anti-inflammatory medications and steroid injections, physical therapy and lifestyle modifications. This article reviews the history and current trends in use for lumbar toral disc arthroplasty for degenerative disc disease treatment. Furthermore, indications, contraindications, and complications management are discussed.
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Affiliation(s)
- Daniel Franco
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA 19107, USA.
| | - Garrett Largoza
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA 19107, USA
| | - Thiago S Montenegro
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA 19107, USA
| | - Glenn A Gonzalez
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA 19107, USA
| | - Kevin Hines
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA 19107, USA
| | - James Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA 19107, USA
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Risk factors for reoperation after lumbar total disc replacement at short-, mid-, and long-term follow-up. Spine J 2021; 21:1110-1117. [PMID: 33640583 DOI: 10.1016/j.spinee.2021.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The reoperation rate following TDR (Total Disc replacement) has been established at short- and mid-term time points through the Food and Drug Administration Investigational Device Exemption (FDA IDE) trials. However, these trials include highly selected centers and surgeons with strict governance of indications. The utilization of TDR throughout the community needs further analysis. PURPOSE To identify the risk factors for lumbar spine reoperation in patients undergoing lumbar total disc replacement (TDR) at short-, mid-, and long-term follow-up. STUDY DESIGN/SETTING This study is a multi-center retrospective cohort study utilizing the New York Statewide Planning and Research Cooperative System database. PATIENT SAMPLE We identified 1,368 patients who underwent an elective primary lumbar TDR in New York State between January 1, 2005 and September 30, 2013. OUTCOME MEASURES The primary functional outcome of interest was lumbar reoperation, specifically the evaluation of independent risk factors for lumbar reoperation at a minimum of 2 years, with sub-analyses performed at 5 and ten years. METHODS International Classification of Diseases, Ninth revision codes were utilized to identify patients undergoing a primary lumbar TDR. We excluded patients with primary/revision lumbar fusion procedures and revision disc replacement procedures. Hospital academic status was determined by the Accreditation Council for Graduate Medical Education. Unique encrypted patient identifiers allowed for longitudinal follow-up for reoperation. Logistic regression models compared reoperation and no-reoperation cohorts, and were performed on sub-analyses for significant univariate predictors of reoperation. RESULTS Between January 2005 and September 2013, 1368 patients underwent a primary lumbar TDR. Reoperation occurred in 8.8% by 2 years, 15.8% by 5 years, and 19.5% by ten years. Diabetics were more likely to have reoperations (7.5% vs 3.8%, p=.013). Teaching hospitals experienced a decreased reoperation rate compared to nonteaching hospitals at 2-year (5.0% vs 10.5%, p=.002), 5-year (10.7% vs 17.9%, p=.002) and 10-year (11.7% vs 21.9%, p=.045) follow-up. Lumbar fusion was the most common reoperation (14.2%). CONCLUSION We identified an 8.8% reoperation rate after inpatient lumbar TDR at 2-years, 15.8% at 5-years, and 19.5% at 10-years. When stratifying by teaching status, reoperation rates at teaching centers align with those reported in FDA IDE studies. Diabetes was the only patient factor influencing reoperation rate. There is a growing consensus that lumbar TDR is a durable and appropriate surgical option for lumbar degenerative disc disease. Proper indications are crucial to obtaining good outcomes with lumbar TDR.
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Katz AD, Perfetti DC, Job A, Willinger M, Goldstein J, Kiridly D, Olivares P, Satin A, Essig D. Comparative Analysis of 30-Day Readmission, Reoperation, and Morbidity Between Lumbar Disc Arthroplasty Performed in the Inpatient and Outpatient Settings Utilizing the ACS-NSQIP Dataset. Global Spine J 2021; 11:640-648. [PMID: 32734775 PMCID: PMC8165934 DOI: 10.1177/2192568220941458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings. METHODS Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof. RESULTS We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no significant differences in rates of specific complications. Inpatient operative time (138 ± 75 minutes) was significantly (P < .001) longer than outpatient operative time (106 ± 43 minutes). In multivariate analysis, diabetes (P < .001, OR = 7.365), baseline dyspnea (P = .039, OR = 6.447), and increased platelet count (P = .048, OR = 1.007) predicted readmission. Diabetes (P = .016, OR = 6.533) and baseline dyspnea (P = .046, OR = 13.814) predicted reoperation. Baseline dyspnea (P = .021, OR = 8.188) and ASA (American Society of Anesthesiologists) class ≥3 (P = .014, OR = 3.515) predicted morbidity. Decreased hematocrit (P = .008) and increased operative time (P = .003) were associated with morbidity in univariate analysis, but not in multivariate analysis. CONCLUSIONS Readmission, reoperation, and morbidity were statistically similar between surgical setting, indicating that LDA can be safely performed in the outpatient setting. Higher ASA class and specific comorbidities predicted poorer 30-day outcomes. These findings can guide choice of surgical setting given specific patient factors.
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Affiliation(s)
- Austen David Katz
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA,Austen Katz, Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Dean Cosmo Perfetti
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Alan Job
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Max Willinger
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Jeffrey Goldstein
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Daniel Kiridly
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Peter Olivares
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | | | - David Essig
- North Shore University Hospital–Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
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Gibson AW, Feroze AH, Greil ME, McGrath ME, Sivakanthan S, White-Dzuro GA, Williams JR, Young CC, Hofstetter CP. Cellular allograft for multilevel stand-alone anterior cervical discectomy and fusion. Neurosurg Focus 2021; 50:E7. [PMID: 34062509 DOI: 10.3171/2021.3.focus2150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative disease of the cervical spine. Given the high rate of pseudarthrosis in multilevel stand-alone ACDF, there is a need to explore the utility of novel grafting materials. In this study, the authors present a single-institution retrospective study of patients with multilevel degenerative spine disease who underwent multilevel stand-alone ACDF surgery with or without cellular allograft supplementation. METHODS In a prospectively collected database, 28 patients who underwent multilevel ACDF supplemented with cellular allograft (ViviGen) and 25 patients who underwent multilevel ACDF with decellularized allograft between 2014 and 2020 were identified. The primary outcome was radiographic fusion determined by a 1-year follow-up CT scan. Secondary outcomes included change in Neck Disability Index (NDI) scores and change in visual analog scale scores for neck and arm pain. RESULTS The study included 53 patients with a mean age of 53 ± 0.7 years who underwent multilevel stand-alone ACDF encompassing 2.6 ± 0.7 levels on average. Patient demographics were similar between the two cohorts. In the cellular allograft cohort, 2 patients experienced postoperative dysphagia that resolved by the 3-month follow-up. One patient developed cervical radiculopathy due to graft subsidence and required a posterior foraminotomy. At the 1-year CT, successful fusion was achieved in 92.9% (26/28) of patients who underwent ACDF supplemented with cellular allograft, compared with 84.0% (21/25) of patients who underwent ACDF without cellular allograft. The cellular allograft cohort experienced a significantly greater improvement in the mean postoperative NDI score (p < 0.05) compared with the other cohort. CONCLUSIONS Cellular allograft is a low-morbidity bone allograft option for ACDF. In this study, the authors determined favorable arthrodesis rates and functional outcomes in a complex patient cohort following multilevel stand-alone ACDF supplemented with cellular allograft.
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Affiliation(s)
| | - Abdullah H Feroze
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Madeline E Greil
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Margaret E McGrath
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Sananthan Sivakanthan
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | | | - John R Williams
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Christopher C Young
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
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van Susante JLC. The (r)evolution of hyped innovations in orthopedic implants: can prudent introduction avoid throwing the baby out with the bathwater? Acta Orthop 2019; 90:507-510. [PMID: 31550954 PMCID: PMC6844368 DOI: 10.1080/17453674.2019.1669115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Job L C van Susante
- Department of Orthopedics, Rijnstate Ziekenhuis, Arnhem, The Netherlands,Correspondence:
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Smith LJ, Silverman L, Sakai D, Le Maitre CL, Mauck RL, Malhotra NR, Lotz JC, Buckley CT. Advancing cell therapies for intervertebral disc regeneration from the lab to the clinic: Recommendations of the ORS spine section. JOR Spine 2018; 1:e1036. [PMID: 30895277 PMCID: PMC6419951 DOI: 10.1002/jsp2.1036] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
Intervertebral disc degeneration is strongly associated with chronic low back pain, a leading cause of disability worldwide. Current back pain treatment approaches (both surgical and conservative) are limited to addressing symptoms, not necessarily the root cause. Not surprisingly therefore, long-term efficacy of most approaches is poor. Cell-based disc regeneration strategies have shown promise in preclinical studies, and represent a relatively low-risk, low-cost, and durable therapeutic approach suitable for a potentially large patient population, thus making them attractive from both clinical and commercial standpoints. Despite such promise, no such therapies have been broadly adopted clinically. In this perspective we highlight primary obstacles and provide recommendations to help accelerate successful clinical translation of cell-based disc regeneration therapies. The key areas addressed include: (a) Optimizing cell sources and delivery techniques; (b) Minimizing potential risks to patients; (c) Selecting physiologically and clinically relevant efficacy metrics; (d) Maximizing commercial potential; and (e) Recognizing the importance of multidisciplinary collaborations and engaging with clinicians from inception through to clinical trials.
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Affiliation(s)
- Lachlan J. Smith
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
| | - Lara Silverman
- DiscGenics Inc.Salt Lake CityUtah
- Department of NeurosurgeryUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | | | - Robert L. Mauck
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Neil R. Malhotra
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Conor T. Buckley
- Trinity Centre for BioengineeringTrinity Biomedical Sciences Institute, Trinity College Dublin, The University of DublinDublinIreland
- School of EngineeringTrinity College Dublin, The University of DublinDublinIreland
- Advanced Materials and Bioengineering Research (AMBER) CentreRoyal College of Surgeons in Ireland & Trinity College Dublin, The University of DublinDublinIreland
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11
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Kovač V. Failure of lumbar disc surgery: management by fusion or arthroplasty? INTERNATIONAL ORTHOPAEDICS 2018; 43:981-986. [DOI: 10.1007/s00264-018-4228-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
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