When it comes to spine surgery, patient characteristics are more important than technology

Jun 10 2011
Medical researchers who investigate the efficacy of spinal surgery options conducted a study that compared a new procedure with a traditional surgical approach for a common condition that may cause chronic neck pain.

Cervical disc disease, which causes compression on the spinal cord or nerve roots, may sometimes result in severe discomfort and is often described as a shooting pain down the arms and hands, especially when an individual is upright or moving the head. The pain is known as radiculopathy, and it sends some 200,000 Americans to the operating table for relief each year. The disease is mainly related to aging, as spinal discs desiccate over time and shrink, causing the space between the vertebrae to narrow and nerve roots to become pinched.

For many years, patients in whom conservative treatments with physical therapy or pain medications failed were referred to orthopedic surgeons for anterior cervical discectomy and fusion (ACDF). The idea behind the procedure is to create a solid union between the affected vertebrae in order to stabilize and strengthen the spine and provide relief from neck pain symptoms.

However, the procedure results in lower spine mobility on account of the fusion of the spinal bones.

Partially for that reason, arthroplasty or artificial cervical disc replacement was approved by the FDA in 2007. During the procedure, the surgeon removes the diseased disc and inserts a device between the vertebrae to preserve motion in the targeted part of the spine and improve its function.

Four years later, a team of researchers from medical and academic centers across the country compared the two surgery options in order to gain more insight into which procedure may provide better overall patient outcomes.

More than 1,200 back surgery patients' data were used for the study. The subjects, whose mean age was between 42 and 44 years old, were divided into two groups such that there were no significant differences between them in terms of age, gender and the rate of tobacco use, among other characteristics.

About half of the entire study group received artificial cervical disc replacement, and the rest underwent ACDF.

The researchers analyzed the data two years after the procedures were performed and found that no statistically significant differences were found in patient outcomes. However, individuals with ACDF had a higher rate of repeat surgery, according to lead investigator Praveen V. Mummaneni, MD, who presented the results at the 79th Annual Scientific Meeting of the American Association of Neurological Surgeons in Denver, Colorado.

He said that, ultimately, "while both of these procedures yielded good results, the most important factor is proper patient selection."

Even though surgical techniques are constantly improving, prevention is the best medicine. Individuals who would like to avoid back or neck pain and surgery should consider practicing proper posture while walking and sitting, engaging in plenty of physical activity and eating a nutritious diet rich in calcium, vitamins C and D, and collagen.