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Utilization Trends of Cervical Artificial Disc Replacement After FDA Approval Compared With Anterior Cervical Fusion: Adoption of New Technology

Lu, Young BA; McAnany, Steven J. MD; Hecht, Andrew C. MD; Cho, Samuel K. MD; Qureshi, Sheeraz A. MD, MBA

doi: 10.1097/BRS.0000000000000113
Epidemiology

Study Design. Epidemiologic study.

Objective. To compare the utilization of anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) in terms of patient and hospital characteristics during the 3 years after Food and Drug Administration (FDA) approval of CDA devices in 2007.

Summary of Background Data. There was a surge in CDA adoption in the 3 years prior to FDA approval of CDA devices in 2007. However, utilization trends of CDA versus ACDF since the FDA approval are unknown.

Methods. The Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the United States in the 3 years after FDA approval of CDA devices (2008–2010). The frequencies of CDA and ACDF were estimated, stratified by patient and hospital characteristics. Average length of hospital stay and total charges and costs were estimated. Multivariable analysis was performed to identify patient and hospital characteristics associated with CDA utilization.

Results. In the 3 years after FDA approval of cervical disc devices, population-adjusted growth rates for CDA and ACDF were 4.9% and 11.8%, respectively (P = 0.6977). Female, African American and Medicaid patients were less likely to receive CDA. CDA was less likely to be performed in patients with cervical spondylotic changes and more likely to be performed in younger and healthier patients. CDA was less likely to be performed in the Midwestern United States or in public hospitals.

Conclusion. The prevalence of CDA increased in the 3 years after FDA approval with a growth rate that is approximately twice than that for ACDF. Although there seems to be CDA adoption, CDA growth seemed to have reached a plateau and ACDF still remained the dominant surgical strategy for cervical disc disease. Possible regional, racial, and sex disparities in CDA utilization and a more strict approach in the selection of CDA over traditional ACDF may have impeded rapid adoption of CDA.

Level of Evidence: 3

Cervical disc arthroplasty (CDA) growth rates declined after its 2007 Food and Drug Administration approval. Anterior cervical discectomy and fusion (ACDF) remained the dominant surgery for cervical spine pathology. Regional, racial, sex, and socioeconomic disparities and a more strict approach in the selection of CDA over ACDF may have impeded rapid CDA adoption.

From the Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, NY.

Address correspondence and reprint requests to Sheeraz A. Qureshi, MD, MBA, Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 East 98 St, 9th Floor, New York, NY 10029; E-mail: sheeraz.qureshi@mountsinai.org

Acknowledgment date: March 26, 2013. First revision date: July 18, 2013. Second revision date: September 7, 2013. Acceptance date: October 29, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, payment for lecture, royalties.

© 2014 by Lippincott Williams & Wilkins