Surgical treatment comparison for spinal disease

Patients with serious degenerative spinal disease, a painful condition in which the normal function of spinal vertebrae breaks down, are presented with what can be a confusing array of surgical options.

A NewYork-Presbyterian Hospital/Weill Cornell Medical Center study looks at five spinal fusion approaches, finding that the use of an anterior cervical plate system, a device used to hold the vertebrae together, significantly increases the fusion rate, a measure of the procedure's success.

Spinal fusion is a "welding" process by which two or more of the small bones (vertebrae) that make up the spinal column are fused together to heal into a single solid bone. The surgery eliminates motion between vertebrae segments, which may be desirable when motion is the cause of significant pain.

Investigators performed a meta-analysis of studies involving a total of 2,682 cases treated with five spinal fusion procedures: anterior cervical discectomy (ACD); ACDF (ACD and interbody fusion); ACDFP (ACDF and placement of an anterior plate); vertebral corpectomy; and corpectomy with placement of an anterior plate. All procedures involve a removal of the diseased disc; some involve the removal of part of the vertebra (corpectomy) and/or the placement of a stabilizing plate.

The paper is published in the April issue of the Journal of Neurosurgery: Spine.

"Patients with painful degenerative spinal disease deserve the surgical approach that will best eliminate their pain over the long-term," says Dr. Roger Hartl, the study's senior author and director of the spine program at NewYork-Presbyterian/Weill Cornell. "Even though the scientific literature shows that plate systems more effectively promote spinal fusion, they are not the most widely used approach. Our results indicate that perhaps they should be."

"While this study is preliminary, the findings support the idea of further research to address this question," adds Dr. Hartl, who is also the Leonard and Fleur Harlan Clinical Scholar and assistant professor of neurological surgery at Weill Cornell Medical College.

For single-disc-level procedures, the most common, the fusion rate was 97.1 percent (329 cases) for ACDFP, compared to 84.9 percent (1,134 cases) for ACD and 92.1 percent (62 cases) for ACDF.

The study also found that for two-disc-level disease, there was no significant difference between ACD with a plate system or corpectomy with a plate system. For three-disc-level disease, however, the evidence suggests that corpectomy with plate placement is associated with higher fusion rates than discectomy with plate placement (ACDFP).

The study's lead author is Dr. Justin F. Fraser, a graduate of Weill Cornell Medical College and currently a resident in neurosurgery at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

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