Spine. Volume 35(24), 15 November 2010, pp E1397-E1405

SWISSspine: The Case of a Governmentally Required HTA-Registry for Total Disc Arthroplasty: Results of Cervical Disc Prostheses

Schluessmann, Eric MD*; Aghayev, Emin MD*; Staub, Lukas MD*; Moulin, Patrick MD†; Zweig, Thomas MD*; Röder, Christoph MD*‡; on behalf of the SWISSspine Registry Group. Author Information: From the *Institute for Evaluative Research in Orthopedic Surgery, University of Bern, Bern, Switzerland; †Swiss Paraplegic Center, Nottwil, Switzerland; and ‡Spine Service Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland. © 2010 Lippincott Williams & Wilkins, Inc.

Study Design. Prospective multicenter observational case-series.

Objective. The goal of the SWISSspine registry is to generate evidence about the safety and efficiency of these Medtech innovations.

Summary of Background Data. The Swiss federal office of public health required a mandatory nationwide HTA-registry for cervical total disc arthroplasty (TDA), among other technologies, to decide about reimbursement of these interventions.

Methods. Between March 2005 and June 2008, 808 interventions with implantation of 925 discs from 5 different suppliers were performed. Surgeon-administered outcome instruments were primary intervention, implant, and follow-up forms; patient self-reported measures were EQ-5D, COSS, and a comorbidity questionnaire. Data are recorded perioperative, at 3 months and 1 year postoperative, and annually thereafter.

Results. There was significant and clinically relevant reduction of neck (preoperative/postoperative 59.3/24.8 points) and arm pain (preoperative/postoperative 64.9/17.6) on visual analogue scale (VAS) and consequently decreased analgesics consumption. Similarly, quality of life (QoL) improved from preoperative 0.42 to postoperative 0.82 points on EQ-5D scale. There were 4 intraoperative complications and 23 revisions during the same hospitalization for 691 monosegmental TDAs, and 2 complications and 6 revisions for 117 2-level surgeries. A pharmacologically treated depression was identified as important risk factor for achieving a clinically relevant pain alleviation >20 points on VAS. Two-level surgery resulted in similar outcomes compared with the monosegmental interventions.

Conclusion. Cervical TDA appeared as safe and efficacious in short-term pain alleviation, consequent reduction of pain killer consumption, and in improvement of QoL. A clinically relevant pain reduction of >=20 points was most probable if patients had preoperative pain levels >=40 points on VAS. A pharmacologically treated depression and 2-level surgery were identified as risk factors for less pronounced pain alleviation or QoL improvement.