In which cases do surgeons specializing in total disc replacement perform fusion in patients with cervical spine symptom
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ORIGINAL ARTICLE
In which cases do surgeons specializing in total disc replacement perform fusion in patients with cervical spine symptoms? Richard D. Guyer1 · Donna D. Ohnmeiss1,2 · Scott L. Blumenthal1 · Jack E. Zigler1 Received: 29 October 2019 / Revised: 29 October 2019 / Accepted: 26 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose was to investigate reasons and their frequency for why total disc replacement (TDR) specialty surgeons performed anterior cervical discectomy and fusion (ACDF) rather than TDR. Methods A consecutive series of 464 patients undergoing cervical spine surgery during a 5-year period by three TDR specialty surgeons was reviewed. For each ACDF, the reason for not performing TDR was recorded. Results TDR was performed in 76.7% of patients (n = 356) and ACDF in 23.3% (n = 108). The most common reason for ACDF versus TDR was anatomical (conditions that may not be adequately addressed with TDR and/or may interfere with device function), which occurred in 64 of 464 patients (13.79%). The second most common reason was insurance (denial/ lack of coverage n = 17, 3.23%), and deformity/kyphosis not addressable with TDR was noted in 13 (2.80%). Pseudoarthrosis repair led to ACDF in three patients (0.65%), two did not receive TDR due to osteoporosis (0.43%), and in two others (0.43%) ACDF was undertaken due to high risk of heterotopic ossification. There was one case (0.22%) each of: nickel allergy, trauma with posterior element fracture, TDR removal, multiple prior cervical spine surgeries, concern about artifact on future imaging studies, benign osteoblastic bone, and limitation to adequate surgical approach for TDR. ACDF patients’ mean age was significantly greater than TDR patients’ (55.3 vs. 46.7 years; p
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