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Cervical arthroplasty had lower reoperation rate than fusion.

PHILADELPHIA -- Cervical disk arthroplasty was slightly less likely to lead to reoperation, compared with cervical fusion, in a post-hoc review of more than 1,200 patients followed for about 16 months.

"In a large population, there was about a 2% higher reoperation rate with fusion, compared with arthroplasty," Paul A. Anderson, M.D., said at the annual meeting of the North American Spine Society.

But the finding cannot be considered definitive because it was a retrospective analysis, he cautioned. The relative durability of disk replacement and cervical fusion surgeries needs to be compared in a study designed to address the issue and follow patients for at least 2 years, said Dr. Anderson, an orthopedic surgeon at the University of Wisconsin in Madison.

The analysis included patients who had undergone disk replacement in any of four arthroplasty trials sponsored by Medtronic Sofamor Danek. Two trials used the Bryan disk, and two studies used Prestige disks; two were done in the United States and two in Europe. All four studies included control patients who underwent cervical fusion.

The Bryan and Prestige disks are still investigational and have not yet been approved for routine use in the United States. Dr. Anderson is a consultant to and receives research support from Medtronic.

His analysis also included the control patients who underwent arthrodesis in a fifth study that compared fusion with the Affinity cage, another spine device made by Medtronic. Overall, the analysis involved data from a total of 649 patients who had disk replacement and 590 patients who had cervical fusion. The average duration of follow-up was 15.3 months in the arthroplasty group and 16.4 months in the arthrodesis group.

During follow-up, the incidence of reoperations was 2.9% in the arthroplasty patients and 4.8% in the fusion patients, a difference that just missed being statistically significant.

The analysis also showed that two-thirds of reoperations in the disk-replacement patients were needed at the same disk level as the initial surgery. In contrast, among patients who had fusion, the second surgeries were evenly split among those done at the same disk level as the first operation and those required at an adjacent level, Dr. Anderson said. The difference was statistically significant.

Reoperation in the arthroplasty patients was most commonly required because of symptoms from nerve-root compression. Second surgery at the index level in the fusion patients was most often needed for pseudarthrosis.

BY MITCHEL L. ZOLER

Philadelphia Bureau
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Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Dec 15, 2005
Words:406
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