In which cases do surgeons specializing in total disc replacement perform fusion in patients with cervical spine symptoms?,European Spine Journal

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In which cases do surgeons specializing in total disc replacement perform fusion in patients with cervical spine symptoms?
European Spine Journal ( IF 2.6 ) Pub Date : 2020-01-02 , DOI: 10.1007/s00586-019-06275-9
Richard D Guyer ₁ , Donna D Ohnmeiss _{1,

2} , Scott L Blumenthal ₁ , Jack E Zigler ₁

Affiliation

Purpose

The purpose was to investigate reasons and their frequency for why total disc replacement (TDR) specialty surgeons performed anterior cervical discectomy and fusion (ACDF) rather than TDR.

Methods

A consecutive series of 464 patients undergoing cervical spine surgery during a 5-year period by three TDR specialty surgeons was reviewed. For each ACDF, the reason for not performing TDR was recorded.

Results

TDR was performed in 76.7% of patients (n = 356) and ACDF in 23.3% (n = 108). The most common reason for ACDF versus TDR was anatomical (conditions that may not be adequately addressed with TDR and/or may interfere with device function), which occurred in 64 of 464 patients (13.79%). The second most common reason was insurance (denial/lack of coverage n = 17, 3.23%), and deformity/kyphosis not addressable with TDR was noted in 13 (2.80%). Pseudoarthrosis repair led to ACDF in three patients (0.65%), two did not receive TDR due to osteoporosis (0.43%), and in two others (0.43%) ACDF was undertaken due to high risk of heterotopic ossification. There was one case (0.22%) each of: nickel allergy, trauma with posterior element fracture, TDR removal, multiple prior cervical spine surgeries, concern about artifact on future imaging studies, benign osteoblastic bone, and limitation to adequate surgical approach for TDR. ACDF patients’ mean age was significantly greater than TDR patients’ (55.3 vs. 46.7 years; p < 0.01). TDR group had significantly more single-level procedures than ACDF (60.8% vs. 43.5%; p < 0.05).

Conclusion

The most common reason for ACDF versus TDR was anatomy that may compromise segmental stability and/or TDR functionality. Older age and greater number of operated levels may be related to anatomical factors, primarily significant osteophytes and severely degenerated facets. These factors, as well as deformity/kyphosis, are more common in older patients and require multi-level treatment. This study found that many patients are good cervical TDR candidates; however, even among TDR specialists, ACDF may be preferred where it is prudent to not take undue risks.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material

中文翻译：

在哪些情况下，专门从事全椎间盘置换术的外科医生在患有颈椎症状的患者中进行融合？

目的

目的是调查为什么全椎间盘置换术（TDR）专科医生执行前颈椎间盘切除和融合术（ACDF）而不是TDR的原因及其频率。

方法

回顾了由三名TDR专科医生在5年期间连续进行的464例接受颈椎手术的患者。对于每个ACDF，记录了不执行TDR的原因。

结果

在76.7％（n = 356）的患者中进行了TDR，在23.3％（n = 108）的患者中进行了ACDF 。ACDF与TDR的最常见原因是解剖学（TDR无法充分解决和/或可能干扰器械功能的病症），这发生在464名患者中的64名（13.79％）。第二个最常见的原因是保险（拒绝/覆盖不足ñ = 17、3.23％），而在TDR中无法解决的畸形/后凸畸形在13中占2.80％。假性关节炎修复导致3例患者（0.65％）发生ACDF，其中2例因骨质疏松而未接受TDR（0.43％），另外2例（0.43％）由于异位骨化的高风险而进行了ACDF。每个病例中有1例（0.22％）：镍过敏，外伤性后路骨折，TDR切除，先前的多次颈椎手术，对未来影像学研究的假象的关注，良性成骨细胞以及对TDR的适当手术方法的限制。ACDF患者的平均年龄显着高于TDR患者（55.3比46.7岁；p <0.01）。TDR组的单级手术明显多于ACDF（60.8％vs. 43.5％；p <0.05）。

结论

ACDF与TDR的最常见原因是解剖结构可能会损害节段稳定性和/或TDR功能。年龄较大和手术水平较高可能与解剖学因素有关，主要是重要的骨赘和严重退化的小面。这些因素以及畸形/后凸畸形在老年患者中更为常见，需要多级治疗。这项研究发现，许多患者是宫颈TDR的良好候选者；但是，即使在TDR专家中，ACDF也可能是比较明智的选择，因为在这种情况下，不要过分冒险。

图形摘要

这些幻灯片可以在“电子补充材料”下找到。

更新日期：2020-01-02

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