Ana Torres (Hospital Universitario Santa Lucia, Cartagena, Spain) reported at the European Federation of National Associations of Orthopaedics and Traumatology congress (EFORT; 4–6 June, London, UK) that a tantalum porous implant (TM-S, Zimmer Spine) is a good alternative to autograft and plate in anterior cervical discectomy and fusion (ACDF) because it is associated with fewer complications and cost savings of €1,473 per patient per year.
Torres commented that avoiding the “inconveniences” of autograft harvesting for fusion procedures had “considerable advantages”, which included reducing surgical time, blood loss, and postoperative pain. However, she added that long-term follow-up data for alternatives to autograft, such as the tantalum implant, were limited. “It is necessary to examine the potential increased costs associated with porous tantalum implants compared with traditional treatment,” Torres noted.
In the study, 61 patients with single-level cervical disc disease with radiculopathy were randomised to receive ACDF with the tantalum porous implant or to receive ACDF with autograft and plate (control group). Clinical status was evaluated using the pain Visual Analogue Scale (VAS), the Neck Disability Index (NDI), and the Zung Depression Scale. The investigators also evaluated the patients’ subjective satisfaction, the complication rate, and the cost-effectiveness of the procedures.
The tantalum group were associated with significant reductions in mean duration of surgery, mean estimated blood loss, and hospital stay compared with the control group. At five years, both groups (compared with their baseline levels) had significant improvements in NDI scores, VAS scores, SF-36 physical component scores, and SF-36 mental component scores with no significant differences in these outcome measures between groups. Torres said: “Also, 82.1% of patients treated with the tantalum implant and 69.7% of patients treated with autograft and plate reported satisfaction at five years.”
However, the number of complications, reported from two to five years after the index procedure, was significantly higher in the control group compared with tantalum group: 12 vs. 3, respectively (p<0.05).
The mean cost of the index procedure, including all costs from the initial visit to hospital discharge, was significantly higher for the control group than for the tantalum group (€7,287 vs. €5,026, respectively; p<0.01). Furthermore while there was not a significant difference in mean quality adjusted life year gained per patient between groups (9.41 patient years for the tantalum group and 7.14 patient years for the control group), the tantalum implant was associated with a cost savings of €1,473 per patient per year.
She concluded: “Therefore, these data show that using a porous tantalum implant as a stand-alone device in ACDF procedures is less costly and more effective than using autograft and plate. The tantalum porous implant is a good alternative for cervical spine interbody fusion.”