Disc replacement may offer advantages in cost and outcomes over spinal fusion

Disc replacement may give better results at a lower cost than spinal fusion for patients with back or neck pain, according to the results of two studies.

The findings, published in the SAS Journal of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery, revealed that patients who underwent disc replacement had hospital costs that were 49% lower at 1 year and were four times less likely to need additional surgery at 4-year follow-up compared with those who underwent spinal fusion.

The potential for disc replacement to be more cost-effective than standard fusion is especially apparent in cases that involve multiple discs, the authors added.

“Estimates vary and are probably understated, but health care expenditures for back pain top $91 billion a year, not including indirect and societal costs such as time lost from work and worker’s compensation,” Rick B. Delamarter, MD, a lead author for both studies, stated in a press release from Cedars-Sinai Medical Center. “It is crucial that we develop surgical procedures that are cost-effective without sacrificing high-quality results.”

Two studies

In one retrospective study, Delamarter and colleagues studied information on 43 consecutive patients with three-level degenerative disc disease who were treated with either disc replacement or circumferential fusion at one hospital between January 2004 and October 2005. Itemized billing records were collected at least 1 year after index surgery, and costs according to hospital service categories were compared between the groups by an analysis of variance and multivariate statistical techniques.

A comparison of the groups showed that patients treated with disc replacement spent a mean of 3 fewer days in the hospital and the cost of hospital services was 49% less excluding instrumentation, according to the study. When accounting for instrumentation, costs were 54% lower.

In the second study, patients were randomized to undergo either replacement using the ProDisc-C (Synthes Spine) or anterior cervical discectomy and fusion (ACDF). Both groups were assessed preoperatively and postoperatively at 6 weeks and 3, 6, 12, 18, 24, 36 and 48 months. Following the randomized portion of the study, 136 continued access patients also underwent replacement with the Synthes device and had up to 24-months follow-up. Evaluations for all groups included the Neck Disability Index (NDI), Visual Analog Scale (VAS) for pain or satisfaction, radiographic examinations and physical/neurologic examinations.

According to the study results, NDI and VAS score improvements from baseline were significant for all patients, but did not differ among groups. VAS satisfaction among the ProDisc-C group was higher at all time points than those in the ACDF group. Patients – continued access and otherwise – who underwent replacement with the Prodisc-C were more likely to say they would undergo surgery again. At the 48-month mark, the investigators found that more patients in the ACDF group required secondary surgery (12 vs. three).

Critical factors

Delamarter highlighted that the cost-effectiveness of disc replacement, as noted by the first study, should be taken into account when deciding how to treat patients unable to recover from back or neck pain.

“After safety and effectiveness of a procedure have been documented, cost is an important consideration,” he stated in the release. “Artificial disc replacement technology appears to offer a promising, cost-saving alternative to fusion, especially for patients with disease at three levels.”

Regarding the second study, Delamarter noted the importance of patient opinion in determining the viability of disc replacement as a treatment.

“While the results of this 13-center study are preliminary, it appears that artificial disc replacement surgery compares favorable as an effective procedure, is preferred by patients and slows the rate of adjacent-level disease,” Delamarter stated in the release.

References:
Buttacavoli FA, et al. Cost comparison of patients with 3-level artificial total lumbar disc replacements versus 360· fusion at 3 contiguous lumbar vertebral levels: An analysis of compassionate use at 1 site of the US investigational device exemption clinical trial. SAS J. 2010;4,4:107-114.
Delamarter RB, et al. Results at 24 months from the prospective, randomized, multicenter Investigational Device Exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up and continued access patients. SAS J. 2010;4,4:122-128.
Disclosure: Delamarter is a consultant for Synthes and receives royalties on the ProDisc devices. However, he does not receive royalties on devices used for his patients or any other patients at Cedars-Sinai Medical Center.

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