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ProDisc Total Replacements Take Less Time in Operating Room Than Do Circumferential Lumbar Fusions

Back pain, the fifth leading cause of hospital admissions in the United States, is the third most common reason for undergoing surgery with the incidence rising from 147,500 in 1979 to 279,000 in 1990 - an increase of 55 percent. Lumbar fusions, surgery that fuses bones together in the lower back, increased 100 percent during this same period. Surgery is done after conservative, non-surgical treatments, such as physical therapy, fail.

Fusion surgery complications include problems developing in neighboring areas above and below the surgical site, long postoperative recovery, pain, disability, and reduced movement, in some patients. As a result, researchers developed disc replacements, or total disc arthroplasty (TDA). Although the differences between the two surgeries are not significant in terms of outcome (60 percent to 90 percent success rates), quicker short-term recovery and return to work with TDA result in reduced cost for the surgical and medical care.

The authors of this article studied 53 patients with disabling back pain and lumbar disc degeneration. Among the group, 36 received an implant called the Synthes Prodisc TDR and 17 underwent a fusion procedure called circumferential fusion. The patients had level 1 or level 2 degeneration disc disease. The researchers evaluated operating room charges, inpatient hospital charges, and implant charges, to determine the cost of the surgeries. The researchers did not evaluate the cost for equipment after surgery, physical therapy, care by attendants, or lost wages and productivity.

The researchers found that patients who had level 1 degeneration had significant differences between the two groups ($12,000 for the replacement group vs. $18,950 for the fusion group) for the operating room charges. Blood loss was higher in the fusion group (794 milliliters) compared with the implant group (412 milliliters). Average time in the operating room for the fusion group was 344 minutes compared with 185 minutes for the implant group. Comparing the time in the hospital, patients in the fusion group stayed a mean of 4.78 days and the implant group a mean of 4.32 days.

The groups with patients who had level 2 degeneration were more similar between the two. The implant group had a average cost of the operating room of $15,340 compared with the fusion group at $20,560 but the overall average cost was $55,524 for the implant group compared with $56,823 for the fusion group. Estimated blood loss was the same between the two groups as was the length of hospital stay. Operating time was an average of 387 minutes in the fusion group and 242 minutes in the implant group.

The authors concluded that the patients who had the implant, regardless of degeneration level, spent significantly less time in the operating room, decreasing those costs.

David A. Levin, MD, et al. Comparative charge Analysis of One- and Two-Level Lumbar Total Disc Arthroplasty Versus Circumferential Lumbar Fusion. In Spine. December 2007. Vol. 32. No. 25. Pp. 2905-2909.


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