Lightning Podiums: Spinal Gumbo - 803A
Presented by: M.F. Gornet
M.F. Gornet(1), F.W. Schranck(2), A.G. Copay(2), K.M. Sorensen(2)
(1) The Orthopedic Center of St. Louis, St Louis, MO, United States
(2) SPIRITT Research, St Louis, MO, United States
Purpose: Extensive evidence is available of the long-term safety and effectiveness of cervical disc arthroplasty (CDA), which is FDA-approved for the treatment of one or two-level cervical pathology. However, little research evidence exists in regard to CDA performed at more than two levels. This study investigates the safety and effectiveness of 3-and 4-level CDA. To our knowledge, this is the largest reported cohort of 3- and 4-level CDA patients to date.
Methods: This is a statistical analysis of prospectively-collected data on patients treated by a single fellowship-trained surgeon. All patients who underwent 3- or 4-level CDA between April 2008 and July 2017 were identified; demographic, diagnostic, and surgical characteristics were recorded and measured. Analysis of patient-reported outcomes (PRO) at 1-, 2-, or 3-year follow-up includes pre-to-post-operative changes in Neck Disability Index (NDI), numerical rating scales for neck and arm pain, and the Veterans Rand 12-item health survey (VR-12) mental component score (MCS) and physical component score (PCS). Chi-square test, t-test, and Wilcoxon rank-sum p-values were used to assess preoperative and postoperative differences for categorical, normally and non-normally distributed continuous variables, respectively.
Results: A total of 87 patients underwent 3-level (71 patients) and 4-level (16 patients) CDA. The sample was 56.3% male with an average age of 50.30 ± 8.68 at surgery, average BMI of 30.42 ± 5.08. There were no significant differences in demographic characteristics between the 2 groups, except for age (49.31 ± 8.89 vs. 54.69 ± 6.11, p=0.024, for 3- and 4- levels, respectively). Average operative time was significantly shorter for 3-level (142.15 ± 35.92 min) than 4-level patients (236.19 ± 64.94 min, p< 0.001). Estimated blood loss was similar in both groups (47.18 ± 11.61 vs. 53.13 ± 12.50, p=0.072). PRO scores were available for 65 patients with a mean postoperative follow-up of 20.69 ± 5.88 months. PRO significantly improved for both groups on all measures (Table below). 89.23% of the patients reported being definitely or mostly satisfied with the surgery, and 80.00% reported being completely recovered or much improved. Four (4.60%) patients (all 3-level) underwent a secondary surgery after 17.00 ± 8.45 months. Three patients underwent further decompression. The fourth patient (C4-C7) had subsidence at C5-C6 and underwent implant removal and fusion at C4-C6.
Conclusions: Patients reported large and significant improvement following 3- and 4-level CDA. These results indicate that 3- and 4- level CDA may be performed safely and effectively in appropriately selected patients.