Trends in Indications and Contraindications for Cervical Disk Arthroplasty from 2009 to 2019

Karim Shafi; Jerry Y Du; Collin W Blackburn; Han Jo Kim; Sravisht Iyer; Sheeraz Qureshi; Randall E Marcus; Todd J Albert

doi:10.1097/BSD.0000000000001589

Trends in Indications and Contraindications for Cervical Disk Arthroplasty from 2009 to 2019

Clin Spine Surg. 2024 Mar 1. doi: 10.1097/BSD.0000000000001589. Online ahead of print.

Authors

Karim Shafi¹, Jerry Y Du¹, Collin W Blackburn², Han Jo Kim¹, Sravisht Iyer¹, Sheeraz Qureshi¹, Randall E Marcus², Todd J Albert¹

Affiliations

¹ Division of Spine Surgery, Hospital for Special Surgery, New York City, NY.
² Department of Orthopedics, University Hospitals/Cleveland Medical Center, Cleveland, OH.

PMID: 38446591
DOI: 10.1097/BSD.0000000000001589

Abstract

Study design: Cross-sectional study.

Objective: Assess trends of indications and contraindications for the use of Cervical Disk Arthroplasty (CDA).

Summary of background data: As spine surgeons become more familiar with CDA, there have been expansions in indications.

Methods: The Medicare Provider Analysis and Review Limited Data Sets for 2009, 2014, and 2019 were utilized. Patients undergoing elective CDA were included. Diagnosis for index surgery and "contraindications" as defined by original CDA Investigative Device Exemption (IDE) criteria were assessed. Variables were identified by the International Classification of Diseases (ICD)-9 or ICD-10 diagnosis and procedural codes.

Results: A total of 1067 elective CDA patients were included. There were 230 patients in 2009, 300 patients in 2014, and 537 patients in 2019. The proportion of patients aged >65 increased from 35% to 51% (P<0.001). Incidence of CDA for radiculopathy increased from 57% to 69% (P<0.001), myelopathy increased from 23% to 78% (P<0.001), and spondylosis without radiculopathy or myelopathy decreased from 19% to 3% (P<0.001). There were increased incidences of ankylosing spondylitis (0.4% to 2.8%, P=0.007), long-term steroid use (1% to 2%, P=0.039), morbid obesity (2% to 6%, P=0.019), and osteoporosis (1% to 5%, P=0.014). The incidence of hybrid CDA and anterior cervical discectomy and fusion (ACDF) decreased from 28% to 23% (P=0.007).

Conclusion: From 2009 to 2019, the number of CDA performed in older patients increased. An increase in the use of CDA for the treatment of myelopathy and radiculopathy and a decrease in the treatment of isolated cervical spondylosis was observed. The proportion of CDA performed in patients with original IDE trial "contraindications" increased. Further research into the efficacy of CDA for patients with contraindications is warranted.