Cervical disc replacement surgery: indications, technique, and technical pearls

Leven, Dante M.; Meaike, Joshua J.; Radcliff, Kris E.; Qureshi, Sheeraz A.

doi:10.1007/s12178-017-9398-3

Cited by 100 publications

(63 citation statements)

References 47 publications

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“…CDA is a relatively new procedure with landmark papers on CDA listing herniated nucleus pulposus (HNP), radiculopathy/myelopathy, spondylosis, and loss of disc height as the main indications for use of the implant (13)(14)(15). The purpose of this study was to examine the trends in CDA utilization and revision rates by analyzing a comprehensive Medicare database between 2005-2014.…”

Section: Discussionmentioning

confidence: 99%

Trends in cervical disc arthroplasty and revisions in the Medicare database

et al. 2018

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Background: Due to increased postoperative complications with anterior cervical discectomy and fusion (ACDF), there has been an increasing interest in the use of cervical disc arthroplasty (CDA). Advancements in prosthetic designs and techniques have improved patient reported outcome measurements and minimized revision rates. There is a paucity in the literature regarding recent trends in CDA utilization and revision rates. The purpose of this study was to determine annual primary and revision CDA trends with the use of an administrative database. Methods: A retrospective review from 2005-2014 was performed using the Medicare Standard Analytical Files from the PearlDiver supercomputer (PearlDiver Technologies, Fort Wayne, IN, USA). Patients who underwent primary CDA were queried using International Classification of Disease, ninth revision (ICD-9) and current procedural terminology (CPT) code 84.62 and 22856, respectively. Revision CDAs were queried using ICD-9 procedure code 84.66. Primary outcomes of this study included annual primary procedures, annual revision incidence (RI), and additional demographic data such as age, gender, geographic location, Charlson-Comorbidity Index (CCI); in addition to length of stay (LOS), cost, and reimbursement. Results: The query returned 2,016 and 517 primary CDA and revision CDA procedures were performed in the Medicare database, respectively. The data showed that the CAGR of primary and revision CDA procedures to be 20.54% and 5.84% (P<0.001), respectively. RI and RB demonstrated a CAGR of −12.22% and −9.61%, respectively. Patients younger than the age of 65 represented the majority of the patients undergoing this procedure. Demographically, primary and revision CDAs were found highest in the South. Conclusions: The data demonstrates a high rate of annual growth in CDA utilization (20.54%) and revision CDA (5.84%), indicating there is an increase demand for CDA in the United States. Compared to ACDF, patients who undergo CDA have improved patient reported outcome measurements and lower rates of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Trends in cervical disc arthroplasty and revisions in the Medicare database

et al. 2018

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“…Artificial disc replacement (ADR) is an alternative to ACDF to treat cervical degenerative disc disease while preserving motion at the operated level to prevent adjacent segment degeneration (ASD) (Pickett et al, 2005;Chang et al, 2007;Upadhyaya et al, 2012;Gao et al, 2015). However, the application of ADR has not been as widely used clinically as ACDF due to strict indications and higher medical cost (Ding and Shaffrey, 2012;Leven et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Optimization of Three-Level Cervical Hybrid Surgery to Prevent Adjacent Segment Disease: A Finite Element Study

Wong

Hsieh

et al. 2020

Front. Bioeng. Biotechnol.

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Hybrid surgery (HS) allows surgeons to tailor fusion and arthroplasty in the treatment of multiple-level cervical disc degeneration. However, the decision making of selecting either ACDF or ADR for each level in three-level HS remains controversial and has not been fully investigated. This study was aimed to optimize three-level cervical hybrid constructs by systematically investigating their biomechanical properties and their effect on adjacent levels. A finite element model of cervical spine (C2-C7) was developed, and eight C3-C6 surgical models including six HS were constructed. The range of motion (ROM) in flexion, extension, lateral bending, and axial rotation under 2.0 Nm moments with 30 N follower load were simulated. The von Mises stress, strain energy at the adjacent intervertebral disc (IVD) and force at the adjacent facet were calculated. The ROM of the hybrid constructs and adjacent levels was close to that of the intact spine. HS with arthroplasty performed at C5-6 had better performance in terms of ROM reduction at the inferior adjacent level (C6-7). Moreover, C-D-D and 3ADR had best performance in reducing the von Mises stress and strain energy at C6-7. All HS reduced the facet burden at both C2-3 and C6-7 levels. However, the major drawback of HS revealed here is that the effect of C6-7 protection is at the cost of increased C2-3 IVD burden. In conclusion, we recommend C-D-D and 3ADR for patient with C3-C6 disc degeneration without predisposing C2-3 condition. C-C-D could be a good alternative with a lower medical cost. This analysis guides the decision making in three-level cervical HS before future cadaver studies or human clinical trials.

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“…Articulation types can be differentiated into balland-socket articulation, which allows rotation around one individual point, and saddle articulation, which allows more than one center of rotation. Intervertebral disk replacements have been performed primarily in the cervical and lumbar spine and have not had widespread use (41,42).…”

Section: Intervertebraldiskreplacementsmentioning

confidence: 99%

Postoperative Spinal CT: What the Radiologist Needs to Know

Ghodasara

Clark

et al. 2019

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During the past 2 decades, the number of spinal surgeries performed annually has been steadily increasing, and these procedures are being accompanied by a growing number of postoperative imaging studies to interpret. CT is accurate for identifying the location and integrity of implants, assessing the success of decompression and intervertebral arthrodesis procedures, and detecting and characterizing related complications. Although postoperative spinal CT is often limited owing to artifacts caused by metallic implants, parameter optimization and advanced metal artifact reduction techniques, including iterative reconstruction and monoenergetic extrapolation methods, can be used to reduce metal artifact severity and improve image quality substantially. Commonly used and recently available spinal implants and prostheses include screws and wires, static and extendable rods, bone grafts and biologic materials, interbody cages, and intervertebral disk prostheses. CT assessment and the spectrum of complications that can occur after spinal surgery and intervertebral arthroplasty include those related to the position and integrity of implants and prostheses, adjacent segment degeneration, collections, fistulas, pseudomeningoceles, cerebrospinal fluid leaks, and surgical site infections. Knowledge of the numerous spinal surgery techniques and devices aids in differentiating expected postoperative findings from complications. The various types of spinal surgery instrumentation and commonly used spinal implants are reviewed. The authors also describe and illustrate normal postoperative spine findings, signs of successful surgery, and the broad spectrum of postoperative complications that can aid radiologists in generating reports that address issues that the surgeon needs to know for optimal patient management.©RSNA, 2019.

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Cervical disc replacement surgery: indications, technique, and technical pearls

Cited by 100 publications

References 47 publications

Trends in cervical disc arthroplasty and revisions in the Medicare database

Trends in cervical disc arthroplasty and revisions in the Medicare database

Optimization of Three-Level Cervical Hybrid Surgery to Prevent Adjacent Segment Disease: A Finite Element Study

Postoperative Spinal CT: What the Radiologist Needs to Know

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