Current trends in spinal arthroplasty: an assessment of surgeon practices and attitudes regarding cervical and lumbar disk replacement.

STUDY DESIGN

Survey study involving orthopedic and neurosurgical spine surgeons.

OBJECTIVE

To report the current practices and opinions of spine surgeons regarding cervical and lumbar total disk arthroplasty (TDA) as alternatives to arthrodesis for the treatment of degenerative conditions of the spine.

SUMMARY OF BACKGROUND DATA

TDA represents an alternative surgical treatment for degenerative spinal conditions that may avoid the deleterious effects associated with fusion. Unfortunately, the prevailing opinions of surgeons about TDA have not been well characterized and the patterns of its utilization have not been documented previously in the literature.

METHODS

A questionnaire was developed to record the attitudes of spine surgeons regarding cervical and lumbar TDA and to assess their utilization of this technology. This survey was distributed to all of the surgeons attending the 2007 "Contemporary Update on Disorders of the Spine" meeting in Whistler, British Columbia.

RESULTS

One hundred thirteen of the 133 surgeons present at the meeting completed the questionnaire, corresponding to a return rate of 85%. The percentage of surgeons who had performed lumbar TDA was significantly higher than that for cervical TDA (42% vs. 30%, P=0.05). However, 81% of respondents stated that they were more likely to perform cervical TDA now compared with 1 year ago, whereas 64% indicated that they were less likely to perform lumbar TDA. The most frequently cited reasons for not performing both cervical and lumbar TDA were questions concerning long-term outcomes and perceived difficulties with obtaining financial compensation from insurance companies; in addition, surgeons were also concerned about revising lumbar TDA cases.

CONCLUSIONS

Although the results of this study confirm that the enthusiasm for TDA was shared by many of these respondents, it is clear that additional long-term, prospective, comparative data are required before this technology may be considered as a replacement for more traditional spinal fusion procedures.