Impact of total disc arthroplasty on the surgical management of lumbar degenerative disc disease: Analysis of the Nationwide Inpatient Sample from 2000 to 2008

Abstract

Background:Spinal fusion is the most rapidly increasing type of lumbar spine surgery for various lumbar degenerative pathologies. The surgical treatment of lumbar spine degenerative disc disease may involve decompression, stabilization, or arthroplasty procedures. Lumbar disc athroplasty is a recent technological advance in the field of lumbar surgery. This study seeks to determine the clinical impact of anterior lumbar disc replacement on the surgical treatment of lumbar spine degenerative pathology. This is a retrospective assessment of the Nationwide Inpatient Sample (NIS).Methods:The NIS was searched for ICD-9 codes for lumbar and lumbosacral fusion (81.06), anterior lumbar interbody fusion (81.07), and posterolateral lumbar fusion (81.08), as well as for procedure codes for revision fusion surgery in the lumbar and lumbosacral spine (81.36, 81.37, and 81.38). To assess lumbar arthroplasty, procedure codes for the insertion or replacement of lumbar artificial discs (84.60, 84.65, and 84.68) were queried. Results were assayed from 2000 through 2008, the last year with available data. Analysis was done using the lme4 package in the R programming language for statistical computing.Results:A total of nearly 300,000 lumbar spine fusion procedures were reported in the NIS database from 2000 to 2008; assuming a representative cross-section of the US health care market, this models approximately 1.5 million procedures performed over this time period. In 2005, the first year of its widespread use, there were 911 lumbar arthroplasty procedures performed, representing 3% of posterolateral fusions performed in this year. Since introduction, the number of lumbar spine arthroplasty procedures has consistently declined, to 653 total procedures recorded in the NIS in 2008. From 2005 to 2008, lumbar arthroplasties comprised approximately 2% of lumbar posterolateral fusions. Arthroplasty patients were younger than posterior lumbar fusion patients (42.8 ± 11.5 vs. 55.9 ± 15.1 years, P < 0.0000001). The distribution of arthroplasty procedures was even between academic and private urban facilities (48.5% and 48.9%, respectively). While rates of posterolateral lumbar spine fusion steadily grew during the period (OR 1.06, 95% CI: 1.05-1.06, P < 0.0000001), rates of revision surgery and anterior spinal fusion remained static.Conclusions:The impact of lumbar arthroplasty procedures has been minimal. Measured as a percentage of more common lumbar posterior arthrodesis procedures, lumbar arthroplasty comprises only approximately 2% of lumbar spine surgeries performed in the United States. Over the first 4 years following the Food and Drug Administration (FDA) approval, the frequency of lumbar disc arthroplasty has decreased while the number of all lumbar spinal fusions has increased.

Complications and Rates of Subsequent Lumbar Surgery Following Lumbar Total Disc Arthroplasty and Lumbar Fusion

“…3,32 Our findings reflected a steady decrease in the utilization of lumbar TDA in California from 2005 to 2010, as well as an increase in the number of lumbar fusion procedures performed, mirroring the trends previously observed on a national level and supporting that our cohort is representative of the country.…”

“…This is likely an inherent problem when comparing these two procedures retrospectively, as other studies have similarly shown differences in their respective patient populations. 32 Our regression analyses did, however, control for patient-specific demographic variables, including age. Lumbar TDA is performed exclusively through an anterior approach, while LF may be performed from a number of approaches.…”

Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

“…1 ). Surgery was performed in the following circumstances: lumbalgia caused by chronic and invalidating discopathy, and resistance to 6 months of medical treatment in an adult <60 years suffering symptomatic discopathy lumbar or lumbosacral discopathy without associated sciatica [ 1 , 2 , 3 , 8 , 9 , 11 , 12 , 13 , 14 , 16 , 19 ]. Patients were evaluated during the preoperative period.…”

“…Advances in the field of lumbar spine surgery have transformed the management of lumbar degenerative disk diseases. Among these techniques, total arthroplasty through an anterior or anterolateral approach has been widely used by spinal surgeons [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. The anterior approach allows complete access to the lumbar discs without incising paravertebral muscles and removing posterior structures.…”

The LP-ESP® lumbar disc prosthesis with 6 degrees of freedom: development and 7 years of clinical experience

“…Articulated TDRs have demonstrated their clinical utility in several patient series. Specifically, the non-inferiority of TDR versus fusion is now generally accepted [13–15, 19]. However, in vitro testing of the two types of implants reveals that both designs have biomechanical advantages and limitations.…”