Current research supports cervical disc replacement as well as fusion, but not much research exists on whether performing a disc replacement at a level adjacent to fusion. Tapan K. Daftari, MD, a spine surgeon with Atlanta-based Resurgens Orthopaedics, and his team are working on biomechanical studies around that question today, with good results.
"This biomechanical research supports that at least biomecanically it's okay to perform an artificial disc procedure adjacent to a fusion," says Dr. Daftari. "At least in the lab setting, the total disc will function as it would if it were done just alone rather than adjacent to a fusion. The conclusion of the study was that the kinematics of the total disc are not significantly altered when it's put adjacent to fusion."
Current FDA guidelines prohibit performing disc replacement adjacent to fusion, but basic research could change that.
"The next step would be to apply disc replacement adjacent to fusion in patients, but that would require an IRB and prospective study," says Dr. Daftari. "I think surgeons are doing this procedure in selected pockets across the country off-label. This study provides the science to back up the procedure. It also opens the potential for doing these surgeries on a more widespread basis after human trials."
For patients who have undergone fusion in the past and need another fusion, performing a disc replacement could provide better results. An initial fusion may cause adjacent segment disease, and a disc replacement at the adjacent level could end that cascade, says Dr. Daftari.
"We are glad that we intuitively thought it would be safe to do the artificial disc adjacent to the fusion and now we're glad to show in this limited study that it was biomechanically safe," says Dr. Daftari.
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