Prevalence of lumbar total disc replacement candidates in a community-based spinal surgery practice

This study was a retrospective record review of consecutive lumbar surgical patients seen by one surgeon in a private, community setting over a 15-month period.

The purpose of this study was to evaluate the potential frequency that candidates for total disc replacement (TDR) might be seen in a community-based spinal surgery practice.

The impact of TDR technology on the practice of spine surgery remains uncertain. The only previous report in the literature evaluating prevalence of contraindications to TDR reflected a patient cohort from a high volume, academic, tertiary referral center, and may not accurately reflect the experiences of the "average" spine surgeon, in community practice. Further, this study did not assess the prevalence of patients who possessed an indication for TDR.

We performed a retrospective chart review of consecutive patients who underwent lumbar spine surgery between 2003 and 2004 (during which period the senior author was in a community-based private practice). Particular attention was paid to conditions considered to be contraindications to TDR. The patients were divided into nonfusion and fusion subgroups. The percentage of patients with exclusion criteria was calculated in each group, as was the percentage of potential TDR candidates.

A total of 190 patients were identified: 124 had nonfusion procedures and 66 had fusion procedures. In the nonfusion group, all patients had at least 1 contraindication to TDR. In the fusion group, 86% of the patients had at least 1 contraindication to TDR. Of those fusion patients with degenerative disc disease, 33% had no contraindication to TDR, and were considered potential candidates for TDR. Seventeen percent of all fusion patients had Worker's Compensation Insurance; among those patients considered to be potential TDR candidates, 44% had Worker's Compensation Insurance, and a further 22% of TDR candidates were on permanent disability (Medicare) as a result of a work-related injury.

This study suggests that in a community-based spinal surgery practice setting, only 14% of fusion patients, and only 5% of all lumbar surgery patients, would be TDR candidates. Furthermore, of those potential TDR candidates, as many as 66% might be expected to have their underlying condition related to a claim of a compensable work-related injury.