Latest developments revealed at NASS

TDR vs. ALIF
An interesting presentation discussing the Maverick (Medtronic) total disc replacement (TDR) versus anterior lumbar interbody fusion (ALIF) with the Infuse Bone Graft/LT-Cage (Medtronic) device, was given by Dr Matthew F Gornet, The Orthopedic Center, St Louis, MO. He explained that for patients with degenerative disc disease (DDD), a total lumbar disc arthroplasty provides an alternative to fusion, designed to alleviate persistent dicsogenic pain and to restore and maintain normal disc height. Gornet reported on an investigational device exemption (IDE) study, which is a prospective, randomised (2:1), controlled study taking place across 31 centres in the US. A total of 405 investigational (TDR) and 172 control (ALIF) patients with single level DDD and no prior surgical treatment were included in the study. The results revealed that the mean TDR vs. ALIF operative time (1.8 vs. 1.4 hours, respectively) and blood loss (240.7 vs. 95.2mL, respectively) differences were significant. However, mean hospital stay (2.2 vs. 2.3, respectively) was not significant. In addition, TDR patients had better satisfaction scores, with 86.2% indicating they would have the surgery again vs. 74.5% in the ALIF group. According to Gornet, the findings demonstrated that treatment with the Marverick Disc consistently demonstrated statistical superiority versus fusion on key clinical outcomes including Oswestry, SF-26 PCS, and back pain scores. In conclusion, the researchers stated that this randomised study validates the benefits of the Maverick Disc for appropriately selected patients in comparison to modern fusion technology.

Bryan cervical disc vs. ACDF
In a Food and Drug Administration (FDA) approved, prospective, randomised clinical trial evaluating the safety and effectiveness of the Bryan (Medtronic) cervical disc replacement as an alternative to anterior cervical discectomy and fusion (ACDF), Dr John G Heller, Atlanta, GA, and researchers found that the Bryan disc (not FDAapproved) showed superior results to ACDF for single-level disc herniations causing radiculopathy or myelopathy. Heller reported that surgical candidates for persistent radiculopathy or myelopathy with single-level disc herniations were included in the study (Bryan, n=242 and control, n=221). The results showed that the cohorts were demographically similar. Over 92% of the procedures were for C5-6 or C6-7, explained Heller. The mean operative time was longer for the Bryan group compared with the ACDF group (2.2 hours vs. 1.4 hours, respectively), while hospital stay was equivalent. The 24-month Overall Success rates were 82.7% and 72.6%, respectively. Ultimate return to work rates were similar among the two groups, however Bryan patients returned to work nearly two weeks sooner than the fusion patients. Heller added that superior results were also observed among Bryan patients with respect to neck pain and Visual Analog Scale (VAS) and days lost from work.

Prevalence of scoliosis in adults.
Dr Khaled Kebaish, Johns Hopkins University, Baltimore, MD, presented the results from a study of 2,973 patients, that investigated the prevalence of scoliosis in individuals aged 40 years and older. He reported that the prevalence of scoliosis in adults varies significantly, normally ranging from 1.9% to 68%. These rates vary depending on what particular definition of scoliosis is used and what patient population in being studied. Dexa Scan images of all patients were obtained between January 2004 and March 2006 at a university hospital to determine the presence of scoliosis using Cobb’s method. Kebaish explained that based on their dataset, 2,973 Dexa scan images showed the prevalence of lumbar scoliosis in adults was 8.85%. The prevalence increased almost linearly from the 6th decade to the 8th decade, and the results also showed that African American has half the likelihood of scoliosis. There was no association between gender and prevalence of the disease. In his concluding remarks, Kebaish reiterated that the study showed that the prevalence of lumbar scoliosis in adults is 8.85%, and that increasing age was associated with increasing likelihood of scoliosis.

Keynote address: Tommy Thompson.
A highlight of NASS, was an enthusiastic talk presented by Tommy Thompson, US Former Secretary of Health and Human Services. In his opening comments, he said that, "The American healthcare system is something we all have to be concerned about." He explained that if things do not change, then the healthcare system will collapse in the next 10-20 years. This statement was supported by the fact that the cost of healthcare in the US will double over the next seven years, and if things do not change now, then companies in the US can not compete with international developments. Thompson said there are shortages of healthcare workers, such as nurses, pharmacists, dentists etc, which will also contribute to the fall of the healthcare system. Medicare in 2013 is predicted to go broke, due to lack of money and Government debt. Thompson then emphasised the importance of education and encouraging surgeons to get involved in fixing the system. He said that changing human nature and tackling the biggest killers such as diabetes, obesity, and cancer start with educating the public. "Lifestyle plays a very important role in healthcare, and to re-train the minds of the US public to be aware of such issues as obesity, will in turn lead to a healthier community and a reduction in healthcare costs," concluded Thompson.