Repeat Surgery After Cervical Discectomy and Fusion

Repeat Surgery After Cervical Discectomy and Fusion

Repeat Surgery After Cervical Discectomy and Fusion

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Traditionally,  spinal surgery  had a bad reputation.  But,  epidemiological studies have demonstrated efficacy of certain procedures.  Recent analysis of the SPORT data indicates that for a matched population of patients with symptomatic disk herniations  there are better long term outcomes for the surgical patient.

Still,  there is the constant fear of spinal surgery leading to additional surgery in the future.  One of the more successful spinal surgeries is Anterior Cervical Discectomy and fusion.  In general, these patients have not responded to non-surgical means,  and therefore elect to undergo the procedure for relief of arm radicular pain.  The success rates are variable,  but the general concensus is improvement of the pain in greater than 90% of the patients.  The concern however, is the long term effects of fusion on the levels above or below the fused level(s).  The development of problems is called Adjacent Segment Disease (ASD),  and with that concern,  there have been a tremendous effort to develop artificial disc replacements in the hope of avoiding ASD and subsequent surgery.  Thus far,  the accumulated data has not been clear about the benefits of artificial disk replacements,  although some studies do show an advantage.  Unfortunately,  other studies do not show less rates of subsequent surgery.   As stated above,  the use of these devices are still too early in its history to know if there is a long term advantage.

But,  the real story is the rate of  developing ASD to the point of having additional surgery.  In the Spine  January 15 2014 article above,  888 patients who underwent Anterior Cervical Discectomy with Fusion over  a 20 year period was followed for the development of surgically significant ASD.  108 had repeat surgery.   That is about  12.2%.  The study also followed these 108 patients,  and about 25% of these patients needed another surgery.

While this is really an epidemiologic  study,  at least in this series of consecutive patients,  we do have some numbers to compare.  We can draw some general ideas about the incidence of additional surgery.  But,  we cannot know if there were other factors that lead to this incidence.  For example,  was the repeat surgery  group of patients associated with a certain type of cervical plating and technique?  Some studies indicate a longer plate that encroaches on the adjacent disk levels can lead to accelerated disk degeneration.  Do the patients with ASD have any other factor such as age,  weight,  medical comorbidities that will effect the development of ASD?

But,  the study is very useful in that I can tell my anterior cervical discectomy and fusion patients,  in general there is a 10-15% incidence of the need for further surgery in the future.   At this time,  I cannot tell them if Artificial Disk replacements can decrease the rate of additional surgery.  But,  there are some compelling arguements to the advance of  artifical disk replacements in younger patients with healthy bone stock.

Citations

  • Arts MP, Brand R, van den Akker E, Koes BW, Peul WC. The NEtherlands Cervical Kinematics (NECK) trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study. BMC Musculoskelet Disord. 2010 Jun 16;11:122. PubMed PMID: 20553591
  • Hisey MS, Bae HW, Davis R, Gaede S, Hoffman G, Kim K, Nunley PD, Peterson D, Rashbaum R, Stokes J. Multi-center, prospective, randomized, controlled investigational device exemption clinical trial comparing Mobi-C Cervical Artificial Disc to anterior discectomy and fusion in the treatment of symptomatic degenerative disc disease in the cervical spine. Int J Spine Surg. 2014;8 PubMed PMID: 25694918

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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