Cervical Total Disc Replacement and Routine Osteoporosis Screening

ISASS19 Meeting Highlight

Peer Reviewed

While osteoporosis is a contraindication for total disc replacement both in the lumbar and cervical spine, new findings suggest that routine DEXA scanning may not be necessary for all cervical disc replacement candidates, Richard D. Guyer, MD, reported at International Society for the Advancement of Spine Surgery (ISASS) 19th Annual Conference held April 3 to 5, 2019 in Anaheim, CA.

Dr. Guyer and colleagues reviewed clinic records from a 5-year period to identify a consecutive series of patients undergoing cervical disc replacement or anterior cervical discectomy and fusion (ACDF) performed by one of three surgeons. They investigated how many of these patients did not undergo cervical total disc replacement due to poor bone quality as determined by DEXA scan.
Cervical spine highlighted in yellow during test scenarioStudy findings suggest that routine DEXA scanning may not be necessary for all cervical disc replacement candidates. Photo Source: 123RF.com.

Low Rate of Osteoporosis Found

“During this five-year period, we identified 365 patients who received a cervical total disc replacement and/or underwent a DEXA screening during evaluation for cervical disc replacement,” Dr. Guyer explained. “Among the 229 patients who underwent a DEXA scan, we found that only 2 patients (0.87%) were ruled out for having a disc replacement due to poor bone quality. Seven other patients who underwent a DEXA scan did not receive a total disc replacement for other reasons.”

The remaining 136 patients did not undergo DEXA screening before receiving cervical disc replacement. In this subgroup, there were no complications related to poor bone quality, such as fracture.

“There appeared to be some selection process among the surgeons prescribing DEXA scanning,” Dr. Guyer said. For example, patients who received a DEXA scan were older than those who did not undergo this screening (mean age 48.8 versus 43.7 years; P<0.01). In addition, one surgeon prescribed DEXA scans more frequently than the other two surgeons (72.8% versus 60.7% and 58.7%; P<0.07). There were no statistical differences in terms of body mass index or gender between patients who or were not scanned.

“In the United States, a DEXA scan and reading costs approximately $100 to $150,” Dr. Guyer told attendees. “Reducing the number of scans could be a cost savings, without increasing complication risks.”

In addition, DEXA scanning is linked to radiation exposure (albeit at a relatively low level), and takes up staff time to schedule scans and chart results, Dr. Guyer noted.

Conclusion

“This study suggests that routine DEXA scanning in all cervical total disc replacement patients may not be necessary,” Dr. Guyer concluded. “In fact, only 0.87% of patients did not receive total disc replacement because of poor bone quality found on DEXA scan. Certainly, if a patient has risk factors for osteoporosis or other indications of bone quality on routine radiographs or computed tomography, a DEXA scan should be performed.”

Disclosures
Dr. Guyer has received royalties from ATEC Spine; has received stock/options from Spinal Kinetics and Spinal Ventures; has served as a consultant or on the Scientific Advisory Board for K2M, Aesculap, Safe Orthopaedics, and Orthofix; and served as a speaker/faculty for K2M and Paradigm Spine.

Updated on: 05/16/19
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Two-Level Cervical Artificial Disc Replacement Update
Richard D. Guyer, MD
Chairman, TBIRF
Texas Back Institute
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