General Session: Cervical Motion Preservation

Presented by: M.F. Gornet - View Audio/Video Presentation (Members Only)

Author(s):

M.F. Gornet(1), R. Wohns(2), J. Billinghurst(3), D. Brett(4), R. Kube(5)

(1) Orthopedic Center of St. Louis, St Louis, MO, United States
(2) NeoSpine, Puyallup, WA, United States
(3) Spine and Ortho Specialists of South Florida, Boynton Beach, FL, United States
(4) Northwest Spine Surgery, Portland, OR, United States
(5) Prairie Spine and Pain Institute, Peoria, IL, United States

Abstract

Introduction: Outpatient spine surgery was reported as early as 1987 for the lumbar spine and 1996 for anterior cervical spine surgery. Trends towards less invasive surgery, as well as modified anesthetic and pain management techniques have resulted in increasing numbers of spinal surgeries being performed in the outpatient setting. Outpatient surgery has been shown safe and effective for anterior cervical discectomy and fusion (ACDF), and more recently, for cervical disc arthroplasty (CDA). The purpose of this analysis is to compare outcomes in CDA patients treated in an ambulatory surgery center (ASC) vs. patients treated in a hospital setting.

Methods: The study was a retrospective collection of data from consecutive patients implanted with the Mobi-C cervical disc at 9 ambulatory surgery centers across the U.S. The historical control group was obtained from the prospective, randomized, concurrent control, multicenter Mobi-C IDE Clinical Trial database. The analysis compared patients treated at an ASC (n=145) with patients treated at a hospital (n=413). The control hospital group (HG) was further classified, per the Medicare definition, as an outpatient (0 or 1-night stay, n=348) or inpatient (2 or more nights, n=65). Each arm included both 1- and 2-level procedures. The following outcomes were available for analysis: surgery time; blood loss; return to work; and subsequent surgery. Subsequent surgeries were those events that occurred between hospital discharge and 90 days, corresponding to the Medicare Global Coverage Period definition for major procedures.

Results: ASC patients had significantly shorter surgery time than the hospital group (72 vs. 112 minutes; p< 0.001), and shorter than each hospital subgroup (outpatient 108, inpatient 133). The ASC group also had less blood loss than the HG (19.3 vs. 59.1 ml; p< 0.001), and also less than each hospital subgroup (outpatient 57.1, inpatient 70.4 ml). Among patients who were working before their surgery, ASC patients returned to work on average 3.2 days sooner than hospital patients, and 2.2 days sooner than the hospital outpatient subgroup (p=0.74, ns). The mean postoperative recovery time for ASC patients was 6 hours (1.8 to 24 hours); eleven ASC patients (7.7%) required an overnight stay. During the 90-day Global Coverage Period, the only cervical-related AE reported was a case of wound dehiscence that required an emergency room visit. There were no hospital admissions and no subsequent surgeries among ASC patients.

Conclusions: CDA patients treated in ASCs had better outcomes than those treated in hospitals, even in an outpatient setting. These results support the hypothesis that CDA with the Mobi-C is safe and effective in an ambulatory surgery center.

Patients Characteristics

Global Coverage Period