Cervical Disc Replacement versus ACDF

 Utility of Provocation Discography in the Evaluation and Treatment of Chronic Low Back Pain

Web survey results for: Janssen ME, Hilibrand AS, Wang JC. Cervical disc replacement vs ACDF. SpineLine. 2005;6(January-February):18-22. 

1. What treatment would you recommend?

21%   would recommend no surgery

11%   would recommend anterior discectomy alone

9%     would recommend posterior foraminotomy alone

23%   would recommend anterior discectomy and fusion

36%   would recommend cervical disc arthroplasty

1. You have (please choose one) confidence that provocation discography is clinically valuable in this case.

47%   full

40%   some

13%   none

2. Do you consider the patient in this case presentation to have a “normal” psychosocial profile?

67%  yes

33%  no

3. How often would you attribute a “failed fusion” to false positive discography?

17%   always

20%   frequently

46%   sometimes

17%   never

4. Do you expect to change your utility of discography based on this presentation?

37%   no

43%   yes, use it more

20%   yes, use it less

  ACDF: Inpatient or Outpatient?  

1. Would you recommend this patient undergo this surgical procedure:

86%   would recommend inpatient at a hospital

14%   would recommend outpatient at an ambulatory surgery center

1. What fusion approach would you use for this patient?
a. 58% would use ALIF alone
b. 14% would use TLIF
c. 14% would use PLIF
d. 14% would use an anterior and posterior combined procedure
e. 0% would use another approach

2. If recommending a hospital-based procedure, your major reason is:

58%    cite concern for medical risks

10%    cite emergency coverage

22%    cite access to assistance & equipment

5%      cite ethical concerns

5%      cite other: ie, acute loss of airway from hematoma or swelling

2. Would you consider other options for this patient?

17%   would consider IDET

33%   would consider disc arthroplasty

33%   would consider two-level fusion

17%   would consider alternative pain management

0%     would consider other options

3. If recommending an outpatient procedure at an ambulatory surgery center, your major reason is:

71%   cite patient satisfaction & preference for shortened stay

0%     cite reduced facility fees

19%   cite efficient environment

10%   cite other: ie, all of the above

1. Do you routinely use psychometric screening
in the assessment of patients in whom you are
considering fusion?

55%   yes

45%   no

2. Do you use the MMPI-2 as the primary test for psychological evaluation?

40%  some times

0       all the time

60%  never

3. If you do not use the MMPI-2 exclusively, what
psychological evaluation tool(s) do you prefer:

12.5%  prefer DRAM

12.5%  prefer MMPI-2 and DRAM

25%     prefer structured clinical interview

50%     replied that it depends on the clinical presentation of the patient

0          indicated other