ACDF vs Total Disc Replacement at Texas Back

In a square-off between total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF), which procedure is more popular—at ground zero for total disc replacement, The Texas Back Institute?

Researchers from the Texas Back Institute set out to determine that and more in their work, “In which cases do surgeons specializing in total disc replacement perform fusion in patients with cervical spine symptoms?” The study appears in the January 2, 2020 edition of The European Spine Journal.

The study team reviewed a consecutive series of 464 patients undergoing cervical spine surgery during a year-year period by three TDR specialty surgeons. For each ACDF, the reason for not undertaking a TDR was noted.

Specifically, the study authors highlighted older age, numerous previously operated levels as well as certain anatomical factors—for example the presence of significant osteophytes or severely degenerated facet joints as the most often cited reasons for opting to perform an ACDF over TDR.

Richard D Guyer, M.D., chairman of the Texas Back Institute Research Foundation in Plano, Texas, explained the outcome of this study to OTW, “We found that 23% of our patients who were evaluated for cervical disc replacement were not candidates. The most common reasons were anatomic factors that would not be addressed by cervical total disc replacement (14%) followed by insurance denial (3%), deformity/kyphosis (3%). Interestingly, osteoporosis was a factor in only 0.43% of the cases. Although most patients were candidates for cervical TDR, ACDF may be preferred where it is prudent not to take any undue risks.”