Washington University spine surgeons in correlation with other facilities are reporting that artificial disc replacement works as well and often better than spinal fusion surgery.
The two procedures are performed on patients with damaged discs in the neck. Researchers found patients who received a disc arthroplasty lost less motion in the neck and recovered faster than those who had an anterior cervical discectomy and arthrodesis with allograft and plate.
“Those who received the artificial disc either did equally as well or a little bit better than those who had fusion surgery,” says K. Daniel Riew, MD, the Mildred B. Simon Distinguished Professor of Orthopaedic Surgery, professor of neurological surgery and chief of the cervical spine service for Washington University Orthopedics.
“One of the most important findings was that people who got the artificial disc were able to preserve all of their motion.”
Patients in the study were randomly assigned to receive either the BRYAN cervical disc or standard fusion surgery. Ultimately, 242 received the artificial disc and 221 had spinal fusion. Improvement following surgery was measured with a neck disability index (NDI). Two years post surgery, patients in both groups had improved NDI scores. Both had less neck and arm pain and were less likely to experience numbness. Overall, the surgery was rated as successful in 83 percent of the patients who received artificial discs and 73 percent of those who had fusion surgery (230 vs. 194). Part of that difference, Riew says, can be explained by better motion in the neck for those who had artificial discs implanted.
In the short term, Riew says most patients receiving artificial disc replacement surgery recovered faster and got back to normal life sooner than fusion surgery patients. “They didn’t need to wear a neck brace after surgery,” he says. “If they had a job, they returned to work faster. And many had a resolution of their pain faster than fusion patients. With a spinal fusion, there are some pain and activity restrictions until the bone is fully incorporated, but with an artificial disc, as soon as the disc is in, it’s ‘good to go.’”
Currently, the artificial discs are not an option for some patients. Those with arthritis or disc disease at multiple levels in the spine are not good candidates. Also, many insurance companies don’t yet cover them.
Heller JG, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled clinical trial. Spine, vol 34 (2).