Introduction: As spine surgeons become more familiar with cervical disc arthroplasty (CDA), there may be changes in trends of indications and contraindications for their use.
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 was assessed. Incidence of “contraindications” as defined by original CDA investigative device exemption criteria were also assessed. Variables were identified by International Classification of Diseases (ICD)-9 or ICD-10 diagnosis and procedural codes.
Results: There was a total of 1067 elective CDA patients included. There were 230 patients in 2009, 300 patients in 2014, and 537 patients in 2019. Age of patients increased with the proportion of patients age < 45 years decreasing from 20% to 10% and the proportion of patients age 65+ increasing from 35% to 51% (p < 0.001). From 2009 to 2019, 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). Incidence of “hybrid” surgery with concurrent anterior cervical discectomy and fusion decreased from 28% to 23% (p=0.007). Incidence of insulin dependent type 2 diabetes increased from 0% to 2.6% (p=0.001), long term steroid use increased from 0% to 2.4% (p=0.002), and morbid obesity increased from 2% to 6% (p=0.019). Incidence of inflammatory arthropathy changed from 3.5% in 2009 to 0.7% in 2014 to 4.1% in 2019 (p=0.018) and osteoporosis changed from 0.9% in 2009 to 2% in 2014 and 0% in 2019.
Conclusion : From 2009 to 2019, there is an increased treatment of older patients with CDA. There has been an increase use of CDA for treatment of myelopathy and radiculopathy and decrease for treatment of cervical spondylosis. There are also general increases in use of CDA in patients with “contraindications” as per the original IDE studies. There should be further clinical studies on the outcomes following CDA for patients with contraindications.
