Home E-Weekly July 11, 2017

Is It Time to Add Same-day Total Disc Arthroplasty?

Published: July 10, 2017

BACK TO BACK In terms of 2-year patient outcomes, complications and disability index scores, researchers saw no significant difference between the 2 outpatient procedures.

Good news in the world of same-day spine: With anterior cervical discectomy and fusion (ACDF) already established as a popular outpatient offering, a new study suggests cervical disc replacement can be performed in an ambulatory setting just as safely and effectively.

ACDF continues to build steam in outpatient settings, but total disc replacement should be the next logical step, according to the authors of the study, published recently in Spine. Although ACDF has long been considered the gold standard for addressing a number of cervical pathologies, the authors say total disc replacement may more closely reproduce the physiologic kinematics of the cervical spine. It may also limit the amount of stress placed on adjacent discs, thereby reducing the incidence of further disease.

The researchers examined the medical records of 55 consecutive patients undergoing single-level total disc replacement, and and compared them with 55 patients who had single-level ACDF. In the process, they found significant improvements in 2-year post-operative outcomes in both groups, with no statistical significance in disability index scores or serious complications, such as post-operative hematomas or worsening post-op pain. Dysphagia was the most common post-op complaint in both groups.

As with past studies about the safety and efficacy of total disc replacement, the authors note "several factors of concern" associated with performing the procedure in an outpatient setting. Chief among them is the potential for airway compromise secondary to a post-op hematoma or soft-tissue swelling. Concerns aside, the authors conclude that single-level total disc replacement can be performed safely on an outpatient basis, with satisfactory clinical and patient-reported outcomes.

Bill Donahue

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