Go Back   ISPINE.ORG Forum > Main forums > Abstracts and Articles
FAQ Members List Calendar Search Today's Posts Mark Forums Read

Abstracts and Articles Discuss ACDF results do not match perception (10% reoperation rate for single level??) in the Main forums forums; Originally posted by slipnslide on Braintalk Hi all! I found this article interesting since my surgeon told me that he ...

Reply
 
LinkBack Thread Tools Display Modes
  #1 (permalink)  
Old 12-28-2010, 08:23 PM
mmglobal's Avatar
Administrator
 
Join Date: Sep 2006
Posts: 2,510
Default ACDF results do not match perception (10% reoperation rate for single level??)

Originally posted by slipnslide on Braintalk
Quote:
Hi all! I found this article interesting since my surgeon told me that he would be doing an ACDF on C5/6/7 and had a 95% success rate .
ACDF results do not match perception

ACDF results do not match perception

“If you ask most spine surgeons about the clinical results of a one-level anterior cervical fusion, typically they would answer that it’s a 95 percent operation—95 percent of patients have excellent results, and fusion rates are 95 percent or better,” Kenneth A. Pettine, MD, told members of the North American Spine Society. Dr. Pettine himself believed those statistics—until he did a meta-analysis of the published results.

“The perception is that this is a great operation,” Dr. Pettine said. “I’m not saying it’s an awful operation. We’re just presenting the data that it’s certainly not 95 percent.”

In fact, based on Level I and Level II data, Dr. Pettine found that anterior cervical decompression and fusion (ACDF) has a 10 percent reoperation rate and a 70 percent clinical success rate.

Using IDE studies
Level I and Level II data were available from five U.S. Food and Drug Administration (FDA) investigational device exemption (IDE) studies involving ACDF as the control procedure. Two studies compared two different types of interbody fusion systems filled with local reaming of autogenous bone versus intervertebral allograft without plating; three studies compared various artificial disks versus intervertebral allograft with plating.

In the first study, the BAK-C fusion system (Zimmer, Minneapolis, Minn.) had a 12 percent reoperation rate; the BAK-C control allograft without plating had a 17.5 percent reoperation rate. Reoperation rates in the second study were 9.2 percent for the Affinity cage system (Medtronic Sofamor Danek, Memphis, Tenn.) and 18.1 percent for the Affinity allograft control without plating. The overall reoperation rate of ACDF without plating was 12.7 percent.

The remaining three studies involved artificial disk systems. The reoperation rates for the ACDF controls were 4.1 percent, 19.9 percent, and 8.5 percent. The overall reoperation rate for ACDF with plating was 9.5 percent.

The five combined studies provided a sample of 1,154 single-level ACDF patients—562 patients fused with a stand-alone interbody cage and 592 fused with an interbody allograft along with a titanium cervical plate.

Thus, based on this analysis, the true result for a one-level ACDF is a 10 percent reoperation rate due to pseudarthrosis, adjacent level degeneration, or revision of the index surgical site, said Dr. Pettine. In addition, the clinical success rate was 70 percent.

The evidence base
This study plays two important roles, according to Dr. Pettine. First, it presents the real ACDF results. Second, this research emphasizes the importance of examining the literature.

Dr. Pettine is currently conducting a more expansive meta-analysis of seven Level I studies on allograft ACDF with plating, which he said is currently considered the U.S. gold standard for fusions.

Dr. Pettine’s coauthor for “Meta-analysis of Class I and II Data on Results of Anterior Cervical Decompression and Fusion” is Lukas Eisermann.

Disclosure information: Dr. Pettine—Medtronic, Paradigm, Spinal Motion, NuVasive; Mr. Eisermann—NuVasive.

Bottom Line

* Spine surgeons generally believe that ACDF is more successful than the data indicate.
* Based on an analysis of Level I and Level II data, however, ACDF has a 10 percent reoperation rate and a 70 percent clinical success rate.

AAOS Now
December 2010 Issue
ACDF results do not match perception
__________________
1997 MVA
2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
Life After Surgery Website
President: Global Patient Network, Inc.
Founder: www.iSpine.org
Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On



All times are GMT. The time now is 07:41 AM.


Powered by vBulletin® Version 3.7.2
Copyright ©2000 - 2018, Jelsoft Enterprises Ltd.