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Spinal Disc Arthroplasty (SDA)s

Degenerative disc disease (DDD) is a common cause of pain and disability. In the past, doctors mainly treated this problem with spinal fusion surgery.  Spinal fusion has shown to have some downsides such as loss of motion and the risk of additional degeneration in the nearby spinal segments. To address these problems, surgeons have been utilizing an alternative type of surgery called spinal disc arthroplasty or replacement.

Initially, disc arthroplasty showed much poorer results than surgeons had hoped. As technology has improved, so have disc replacement patient outcomes. Currently, both cervical and lumbar disc arthroplasty are showing promise as ways to treat degenerative disc disease. They have been found to have good results with lower rates of adjacent disc problems. Like any major surgery, disc arthroplasty also has risks, such as implant migration, osteolysis, and heterotopic ossification. The design of the implants is continuing to improve to help lower these risks. Although not yet as common as spinal fusion surgery, disc arthroplasty is becoming more popular and research is aggressively advancing to find better solutions for back pain patients.

Disc Replacement Research Highlights

1. Cervical Disc Arthroplasty (CDA): An Update on Current Practices

  • The potential advantages of CDA are based on the premise that preservation of spine mobility and load-sharing at the treated level leads to longevity of the facet joints and decreases the risk of adjacent segment degeneration.
  • Results of randomized clinical trials show similar-to-improved patient reported outcomes for multilevel CDA versus anterior cervical discectomy and fusion (ACDF) with lower rates of revision surgery at index and adjacent levels and lower rates of serious adverse device-related events (out to 5-10 years).
  • 3- and 4-level CDA statistical improvement in patient-reported outcomes with a low rate of secondary surgeries (out to 7 years), suggesting multilevel CDA may be performed safely and effectively in appropriately selected patients
  • CDA not only results in superior clinical outcome, but also is less costly over a 7-yr time period for patients with symptomatic degenerative disc disease versus ACDF.

Read Full Article: [Int J Spine Surg, Published online 2020. PMCID: PMC7528764]

2. Cervical disc replacement (CDR): Examining “real-world” utilization of an emerging technology

  • Nationally, the utilization of single-level CDR increased from 5.6 cases per 100 ACDFs in 2009 to 28.8 cases per 100 ACDFs in 2017 - with the most substantial increases occurring from 2013 onward.
  • Patient factors that increased the odds of having CDR were age <40 years, no clinical evidence of myelopathy/myeloradiculopathy, and patients having fewer high-risk comorbid condtions.

Read Full Article: [J Neurosurg Spine, 2020. PMID: 31952042]

3. Osteolysis after cervical disc arthroplasty

  • Osteolysis (process of progressive destruction of periprosthetic bony tissue) after cervical disc arthroplasty is common, but the majority of cases are limited to mild or asymptomatic presentations that do not require revision surgery.
  • Severe asymptomatic bone loss (exposure of the implant) was found in less than 4% of patients.
  • Symptomatic patients with osteolysis may require surgical removal of implant and conversion to fusion.

Read Full Article: [Eur Spine J, 2020. PMID: 32865650]

4. Patient selection in cervical disc arthroplasty

Indications /contraindications (patient selection criteria) of the approved US CDA devices.
  • Strict adherence to on-label use of CDA excludes more than 50% of patients diagnosed with cervical degenerative disc disease
  • Candidate indications/contraindications not heavily debated include osteoporosis, severe facet degeneration, prior cervical spine surgery, and significant loss of disc height
  • More Than 2 Levels (Including Noncontiguous Levels): Due to limited evidence, surgeon perception of the use of CDA at >2 levels remains mostly unfavorable in the United States.
  • Revision of Failed Fusion: CDA used in revision of failed fusion remains controversial in the US, with little to no published supporting data
  • Kyphosis: Limited studies report that postop kyphotic changes in CDA patients do not impact outcomes. However, the majority of US surgeons eliminate patients with kyphosis as candidates for CDA.
  • Disc replacement decisions continue to be influenced by insurance approval, sometimes requiring on-label use. Literature overwhelmingly confirms the safety and efficacy of CDA and cost analyses indicates that it is a clear money-saver in the long term.

Read Full Article: [International Journal of Spine Surgery August 2020. DOI: 10.14444/7088]

Spinal Disc Replacement Summary

As an orthopedic surgeon, I have seen a growing interest in motion-preserving disc arthroplasties as a treatment option for spinal disc pathology. Traditional spinal fusion procedures can lead to loss of motion and increased risk of problems in nearby segments. Disc arthroplasty aims to address these issues by preserving motion in the spine. In the past, early implant designs led to poor patient outcomes. However, with advances in technology and design, more recent studies have shown promising results when comparing disc arthroplasty to traditional fusion. In fact, the use of cervical disc arthroplasty has nearly tripled in the past 7 years. While disc arthroplasty offers advantages over fusion, it is important to note that it also has its own risks such as implant migration, osteolysis, and heterotopic ossification. As more surgeons adopt these procedures, there is increasing focus on improving implant designs to minimize these risks. Overall, cervical and lumbar disc arthroplasty are showing great promise and are becoming more common in the treatment of disc pathology.

For The Latest Spinal Disc Replacement Information

The Bone and Joint Institute of Tennessee’s spine specialists offer personalized surgical and non-surgical treatment for neck and back problems. Whether you’re suffering from trauma, injury, arthritis or other orthopaedic condition, our experts will help relieve pain and restore mobility. We offer the most up-to-date surgical care for spinal conditions, including total disc replacement and minimally invasive spinal surgery. It’s important to note that not all spinal problems require surgery, and we recognize that every patient is different. That’s why our specialists seek out the least invasive and most effective treatment option for each patient. Physical therapy and rehabilitation are also essential elements of spinal care, and we have an experienced team of medical professionals armed with the latest recommendations and tools to help promote healing. For more information or to schedule an appointment, call 615-791-2630.

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Cory Calendine, MD is an Orthopaedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopaedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.  
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