Cervical disc replacement procedures rapidly gain popularity as the preferred alternative to cervical fusion

Spine

Cervical fusion has traditionally been the standard procedure performed for an array of common cervical conditions such as disc degeneration, bone spurs, herniated discs, radiculopathy and spinal stenosis.

 

However, cervical fusions are prone to low success rates and recovery complications, which have become a growing concern in recent years among doctors and well-informed patients.

 

Cervical fusions require the natural mobility of the neck to be sacrificed for stability, especially with multi-level fusions. Coupled with that lack of mobility is the probability of accelerated disc degeneration due to added stress on the neighboring discs. Patients with multi-level fusions tend to experience disc degeneration at a quicker rate, forcing them to go down a path of secondary surgeries to remedy the pain.

 

Cervical artificial disc replacement is currently the procedure preferred by U.S. physicians as the minimally invasive, mobility-preserving alternative to cervical fusion. Many of these doctors are witnessing a rise in the need for disc replacement either in place of a fusion or as a secondary procedure due to a previous, failed fusion. With the rising demand for disc replacement, the most advanced, FDA-approved and minimally invasive disc technology has become more widely available to physicians. Top-selling devices include LDR's Mobi-C Cervical Disc, which is approved for multiple-level disc replacements, and Medtronic's BRYAN Cervical Disc.

 

Dr. Scott Katzman, MD, who specializes in artificial disc replacement and boasts a 98% success rate, recently performed his 250th cervical disc replacement using the Mobi-C Cervical Disc at his New Jersey-based orthopedic practice, NJ Spine & Orthopedic. NJ Spine & Orthopedic's team of physicians have seen an influx in the amount of cervical disc replacements they've performed over the last two years leading up to Dr. Katzman's notable 250th surgery. This rise, Katzman says, is owed to the practice's surgical expertise and dedication to advancing their own minimally invasive methods in tandem with increasing patient awareness of fusion setbacks and minimally invasive treatment alternatives.

 

"About 25 percent of the artificial disc replacements we perform are revision surgeries as a result of previously failed or nonunion fusions," said Katzman. "Our practice continues to experience an increasing number of patients coming in the door with fusion complications like disc degeneration. These patients have already had one surgery and are extremely wary of undergoing a second revision surgery, so our focus is on developing the most advanced, minimally invasive techniques possible so we can achieve long-term pain relief for our patients."

 

Cervical disc replacement as a remedy for smokers with fusion complications

 

Cervical disc replacement has additional leverage in the orthopedic industry due to the problematic relationship between smoking and fusions. A large number of orthopedic surgeries have traditionally been deemed high-risk procedures for patients who smoke, and cervical fusions are no exception. The already-low success rate of a cervical fusion may be further decreased if the patient is a smoker. Cervical fusions in smokers have a high incidence of nonunion due to the reduction of microvascular circulation caused by smoking. During the act of smoking, microvascular circulation is destroyed, so without blood properly being brought to the vertebrae in the process of healing, spinal union does not occur.

 

Fortunately for physicians with patients who smoke, there is still a light at the end of the tunnel in a failed surgery or nonunion scenario with cervical disc replacement. With no fusion involved, the risks for smokers are drastically reduced and mobility is reinstated, because surgeons are able to revert the original fused area back to a working spine segment.

 

Cervical disc replacement studies show effectiveness

 

A growing body of evidence supports artificial disc replacement as a superior treatment solution in terms of success rate, pain relief and general patient wellbeing.

 

The Journal of Lancaster General Hospital conducted a study that compared cervical disc replacement (investigational group) with a standard anterior cervical discectomy (control group). Results indicated cervical disc replacement offered significantly better long-term sustainability and pain reduction.

 

At 24 months, all patients in the investigational group felt that their condition had improved; 57 percent reported success at relieving neck pain and felt "completely recovered" versus 33 percent in the control group. The remaining 43 percent of the investigational group reported they were "much improved" after a cervical disc replacement, versus 39% of the control group who reported feeling "much improved" after a standard discectomy.

 

Physicians' perceptions of the outcomes at 24 months also indicated cervical disc replacement as the more effective treatment in comparison to a standard anterior cervical discectomy. In the investigational group, 79 percent of physicians reported outcomes were "excellent," versus 39 percent in the control group. 21 percent reported "good" versus 52 percent, and "fair" came in at 0 percent versus 9 percent.

 

Although this study, along with multiple others, concludes cervical disc replacement as a superior treatment to traditional procedures like cervical fusion, few studies have been done on the more advanced, recently available cervical disc technology in association with the procedure.

 

The promising future of cervical disc replacement

 

The increasing popularity of fusion alternatives does not appear to be slowing down any time soon – a 2014 Millennium Research Report suggests the spinal non-fusion industry is expected to increase in size by almost 300% by 2022.

 

Recognizing the large population suffering from failed surgeries is an important step for most doctors in adopting cervical disc replacement as the primary minimally invasive treatment for their qualifying patients.

 

"Cervical disc replacement has turned out very well for our patients, and I predict as more research and development goes into both the methods and the technology used, the procedure will be seen as the ideal treatment solution for those who qualify for surgery," said Katzman. "This procedure is a long-term investment in a patient's quality of life and has a higher success rate than cervical fusion. For patients, this translates to less surgeries, less recovery time and less time spent in pain."

 

After 250 cervical disc replacements, Dr. Katzman and his team feel optimistic about the future of corrective spine surgery. As advancements continue to be made in cervical disc replacement technology, more patients and surgeons will predictably recognize the procedure's advantages over fusion.

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