ISASS20: Opioid use lower for Prestige LP cervical disc patients

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The percentage of patients using opioid medication once or more a day after receiving the Prestige LP cervical disc arthroplasty (CDA) (Medtronic) was statistically lower than those undergoing two-level anterior cervical discectomy and fusion (ACDF), according to 10-year follow-up findings presented at the International Society for the Advancement of Spine Surgery (ISASS) annual meeting (ISASS20; February 26–28, San Juan, Puerto Rico, USA). The findings were presented at ISASS20 by Scott Hodges (Center for Sports Medicine and Orthopaedics, Chattanooga, USA).

In his presentation, Hodges explained that previous publications from the US Food and Drug Administration (FDA) Investigational Device Exemption (IDE) randomised study that compared two-level Prestige LP CDA with two-level ACDF had demonstrated statistical superiority for CDA in the primary and many secondary endpoints, including overall success, neck disability index (NDI), and neck pain, as well as secondary surgeries at both the index and adjacent levels up to 10 years. The greater outcome improvements, he said, may lead to less use of pain medications for CDA patients. The paper presented at ISASS20 compared frequency of opioid medication use between Prestige LP CDA and ACDF subjects from that study.

During the initial FDA IDE study, a total of 397 subjects having two-level degenerative disc disease (DDD) with intractable radiculopathy and/or myelopathy were randomised into either CDA (n=209) or ACDF (n=188) treatment groups. At six weeks, three and six months pre-operatively, and one, two, three, five, seven, and 10 years postoperatively, subjects were asked how often during the previous week they had used pain medications for their neck or arm pain, for weak and strong narcotics respectively. They were asked to respond: “not at all (0)”, “once a week/as needed (1)”, “once every couple of days (3.5)”, “once or twice a day (10.5)”, and “three times or more a day (21).”

medtronic prestige LP for artificial disc replacement
Medtronic’s Prestige LP cervical disc

For the analysis presented by Hodges, weak and strong narcotic medications were combined as total narcotic uses. A weight, i.e., 0, 1, 3.5, 10.5, and 21 was given for each frequency. The resulting total score estimated the number of times narcotic medications were reportedly used per week.

Hodges and colleagues found that at the pre-operative stage, the percentages by group—47.8% for CDA and 44.4% for ACDF—were similar (p=0.545). And, while it was found that the percentages decreased substantially for both CDA and ACDF groups after surgery, Hodges and colleagues report that the percentages of CDA patients who used narcotic medications once or more a day were significantly lower.

The study group concluded that the percentages of subjects who used opioid medications once or more a day after receiving the Prestige LP CDA were statistically lower than those in the ACDF group overall and at most postoperative time points.


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