2017 Charles D. Ray Award Winner Is Pierce Nunley and Colleagues

The 2017 Charles D. Ray Award for Best Clinical Paper has been conferred upon Pierce Nunley, M.D. and colleagues for their work on adjacent segment pathology.

Dr. Nunley, director of the Spine Institute of Louisiana in Shreveport, received the award at the recent meeting of the International Society for the Advancement of Spine Surgery (ISASS).

The work, “Radiographic Adjacent Segment Pathology Following Treatment with TDR or ACDF at One or Two Levels: A Prospective, Randomized, Controlled FDA Clinical Trial at Seven Years,” is being finalized for publication.

The authors wrote, “Adjacent segment pathology (ASP) continues to be a major concern for patients undergoing treatment with cervical disc arthroplasty (CDA) or Anterior cervical discectomy and fusion (ACDF). Degenerative changes at adjacent levels after initial surgical treatment can lead to the reemergence of symptoms prompting additional surgical intervention.”

“The motion preserving capabilities of CDA have been documented and are hypothesized to produce lower rates of ASP compared to ACDF. However, few studies have explored the influence of CDA on ASP in the long-term. More importantly, evidence of the effect of multilevel CDA on ASP is limited. Here we evaluate and compare radiographic ASP (rASP) in patients treated with one- or two-level ACDF or CDA.”

“Data was collected in a prospective, randomized, controlled clinical trial comparing total disc replacement (Mobi-C artificial disc) to ACDF with allograft and anterior plate at one or two contiguous levels. The patient population consisted of 575 randomized patients: 164 patients were treated with one-level CDA and 81 with one-level ACDF; 225 patients were treated with two-level CDA and 105 with two-level ACDF.”

Dr. Nunley told OTW, “We found that the rate of rRASP is significantly decreased for cervical total disc replacement (cTDR) versus ACDF at seven years.”

“The progression of rASP is significantly greater for ACDF with a marked decline through three years and continued divergence between the treatments through seven years. Secondary surgeries performed at the adjacent level are also significantly more prevalent with ACDF treatment when compared to cTDR. These differences in rASP are more pronounced in 2-level cases. We hope it will increase the adoption of cTDR for on-label indications, particularly for 2-level cases.”

“This study was a strictly controlled IDE [investigational device exemption] study, therefore it is important to understand the results apply to a patient population that met the inclusion/exclusion criteria. However, the indications of approved cTDR devices do represent a significant percentage of patients that undergo cervical surgery for radiculopathy/myeloradiculopathy.”