Disc Replacement Holds Advantages Over Standard Fusion Surgery

Two new studies suggest that for patients with back and neck pain, especially when several discs are involved, artificial disc replacement may give better long-term results than standard fusion surgery, and at a lower cost.

Researchers at the Cedars-Sinai Medical Center (Los Angeles, CA, USA) reviewed 209 patients with damaged cervical discs who received either minimally invasive disc replacement or complex spinal fusion surgery; these patients were followed at regular intervals for four years; a separate group of 136 patients who received an artificial disc two years after the first group were also part of this study. All patients were assessed on their satisfaction with the results of the procedure. The second study focused on 53 patients suffering from three-level, lumbar disc disease and looked at cost comparisons for length of hospital stay, resources used, and other factors.

The results showed that four years after surgery, nearly 88% of disc replacement patients reported that they were very to completely satisfied, compared with 76% of fusion patients. Improvements were seen in both flexibility and range of motion; physical and neurological improvement; and in self-assessed neck disability, and neck and arm pain intensity. These improvements were seen irrespective of the surgical procedure, but results tended to be at least slightly better in patients with disc replacements. An important finding was that four years out from surgery, fusion patients were four times more likely to need more surgery, with half of these secondary operations needed to treat new disc problems occurring adjacent to fused sections. Both studies were published in December 2010 issue of the SAS Journal.

"While the results of this 13-center study are preliminary, it appears that artificial disc replacement surgery compares favorably as an effective procedure, is preferred by patients and slows the rate of adjacent-level disease,” said lead author of both studies orthopedic surgeon Rick Delamarter, MD, codirector of the Cedars-Sinai Spine Center. "After safety and effectiveness of a procedure have been documented, cost is an important consideration; artificial disc replacement technology appears to offer a promising, cost-saving alternative to fusion, especially for patients with disease at three levels.”

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