The state of total disc replacement in 6 studies


Total disc replacement is a procedure that continues to catch the interest of spine surgeons. Here are six recent studies that illustrate where the procedure is today and where it's heading.

1. Hospital charges for elective total cervical disc replacement increased significantly from 2009 to 2019, Medicare reimbursement hasn't kept up, according to a study published in the November 2023 issue of the Journal of Neurosurgery. The researchers examined the Medicare Provider Analysis and Review Limited Data Sets for 2009, 2014 and 2019 to gather data on patients who underwent elective cervical disc replacement. They used the Medicare Physician Fee Schedule Look-Up Tool to gather data on the physician fees and adjusted for inflation based on the Consumer Price Index. The average hospital charges for elective cervical disc replacement jumped 73% over the study period to $111,874 ± $78,611 by 2019 and total cost of index hospital admissions jumped 26% to $24,682 ± $13,818. The reimbursement to surgeons for cervical disc replacement dropped 7% over the decade to $1722 ± $138. Hospital profit from cervical disc replacements also dropped 121%. The reimbursement to surgeons for cervical disc replacement dropped 7% over the decade to $1722 ± $138. 

2. The volume of cervical disc replacements grew steadily for nearly a decade, but have leveled off in the last few years, according to a study published in the journal Spine. Researchers examined data for cervical disc replacement and anterior cervical discectomy and fusion entered into the PearlDiver M151Ortho data set. There were 19,301 single-level disc replacements and 181,476 ACDFs performed over the study period, 2010 to 2021. Disc replacement use relative to ACDF jumped from 4% in 2010 to 14.15% in 2018. By 2021, the proportional utilization was just slightly increased to 14.47%.Younger patients and patients with commercial insurance were more likely to undergo disc replacement than spinal fusion, and orthopedic spine surgeons were more likely to perform disc replacements than neurological surgeons.

3. New data from Orthofix found its M6-C cervical disc saw better outcomes than anterior cervical discectomy and fusion after 5 years. The FDA-approved investigational device exemption findings, published in The Spine Journal, found that after 5 years, M6-C had 82.3% composite clinical success while ACDF had 67% CCS. Rates of subsequent surgical interventions were 3.1% for disc replacement and 5.3% for ACDF. Patients with single-level symptomatic cervical radiculopathy with or without cord compression across 23 sites in the U.S. were evaluated for the study.

4. Although the cost of cervical disc replacement and anterior cervical discectomy and fusion surgery costs are similar, long-term costs are different, according to a study in the April issue of Spine. Researchers used a commercial insurance claims database to analyze data from patients who had one- or two-level ACDF and cervical disc replacements between Jan. 1, 2017, and Dec. 31, 2017. A total 2,304 patients were included — 1,723 ACDF patients and 581 disc replacement patients. Prices for the surgeries were similar with ACDF mean costs of $26,819, and disc replacement mean costs of $25,954. However postoperative care — which includes physical therapy, pain medication, injections, psychological treatment and additional spine surgeries — cost less for disc replacements after 30 days, 90 days and two years.

5. Over 20 years, only 1.26% of lumbar disc replacements have needed a follow-up revision surgery or removal, spine surgeons at Texas Back Institute found. Their research, published in the May 15 issue of Spine, looked at data from 2,141 lumbar disc replacements since 2000. Of the total patients, disc removal was done in 24 patients, and 12 patients needed revisions. About 40% of removals and revisions happened in the first 25 total disc replacement cases done by individual surgeons. There was also a patient who had a "significant vascular complication" that was removed after trauma. 

6. Cervical disc replacement may have advantages over minimally invasive posterior cervical foraminotomy to treat cervical radiculopathy, according to a study published in the May 2024 issue of The Spine Journal. The study included 152 patients who had surgery for cervical radiculopathy at one institution between 2012 and 2020. Eighty-six had cervical disc replacement and 66 had minimally invasive posterior cervical foraminotomy. The disc replacement group had longer mean operating time but comparable blood loss and length of stay to cervical foraminotomy, researchers found. The disc replacement group had greater complication rates but that was primarily driven by approach-related dysphagia in most patients. The cervical foraminotomy group had greater revision rates, while the disc replacement group had significantly greater improvements in Neck Disability Index scores at the last follow-up.

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