Specialty Update   |    
What's New in Spine Surgery
Keith H. Bridwell, MD1; Paul A. Anderson, MD2; Scott D. Boden, MD3; Alexander R. Vaccaro, MD4; Jeffrey C. Wang, MD5
1 Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address: bridwellk@wudosis.wustl.edu
2 Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital, 600 Highland Avenue, Suite K4-736, Madison, WI 53792-0001. E-mail address: anderson@orthorehab.wisc.edu
3 Emory University School of Medicine, 59 Executive Park South, Suite 3000, Atlanta, GA 30329. E-mail address: Scott_boden@emoryhealthcare.org
4 Rothman Institute at Jefferson, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107-4216. E-mail address: alexvaccaro3@aol.com
5 Department of Orthopaedic Surgery and Neurosurgery, University of California at Los Angeles School of Medicine, 1250 16th Street, 7th Floor Tower, Room 745, Santa Monica, CA 90404. E-mail address: jwang@mednet.ucla.edu
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of more than $10,000 (Medtronic, Stryker, Seaspine, Osprey, Aesculap, Biomet, Amedica, Zimmer, Alphatech) and less than $10,000 (DePuy) or a commitment or agreement to provide such benefits from these commercial entities. In addition, one or more of the authors has investments or has received stock options in the following commercial entities: Fziomed, Promethean Spine, Paradigm Spine, Benvenue, NexGen, K2 Medical, Pioneer, Vertiflex, Electrocore, Surgitech, Invuity, Axiomed, Bone Biologics, VG Innovations, Corespine, Expanding Orthopaedics, Syndicom, Curative Biosciences, Facet Solutions, and Pearldiver.

Specialty Update has been developed in collaboration with the Board of Specialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 18;92(10):2017-2028. doi: 10.2106/JBJS.J.00434
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Three cervical disc arthroplasty devices are currently approved for patient care in the United States. There are different kinematic designs (ball and socket, ball and trough, and mobile center core) and different bearing couples (stainless steel metal on metal, cobalt-chromium on polyethylene, and titanium on polycarbonate-polyurethane). Other designs with cobalt-chromium metal-on-metal bearing surfaces are also being investigated in pivotal clinical trials. No clinical differences are apparent between these devices at this time. The four and five-year results of randomized clinical trials comparing arthrodesis with arthroplasty after decompression for the treatment of single-level cervical disease have shown equal or better results following arthroplasty as compared with arthrodesis in terms of overall clinical success, pain, and functional improvement, and the results have been stable over time. Revision rates of 2% to 5% have been seen following arthroplasty, and in these trials no device failures or wear-associated complications have been observed. Pooled data indicate that the rates of reoperation are significantly higher following arthrodesis, at both the index and adjacent levels. Two cases of apparent metal hypersensitivity causing a pseudotumor with symptomatic spinal cord compression following the placement of a cobalt-chromium metal-on-metal cervical prosthesis have been reported. These cases were similar to the pseudotumor reactions seen in some patients following metal-on-metal total hip arthroplasty.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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