SPINE Volume 39, Number 22, p E1338 ©2014, Lippincott Williams & Wilkins
SURGERY
Point of View Brian W. Su, MD,* and Alexander R. Vaccaro, MD, PhD†
O
steocel is minimally manipulated tissue that contains mesenchymal stem cells. It is not known how many of the cells are retained locally and how many differentiate into bone-producing cells. Despite its widespread use, there have been few studies that critically document its success in obtaining fusion (computed tomography grading) in any part of the spine. This study provides the readership with the first prospective study using Osteocel in an anterior cervical discectomy and fusion (ACDF). At 2 years, 92% of singlelevel ACDFs demonstrated successful fusion. Although this study did not include a control group, based on the ACDF arm of the cervical disc replacement studies, Osteocel in polyetheretherketone (PEEK) clearly compares favorably with the structural allograft use. The question, however, goes beyond the effectiveness of Osteocel in assisting fusion in the spine. It really is whether Osteocel in a PEEK spacer adds value to an ACDF. Value is defined as the cost of the intervention versus the quality of outcome over time. In an operation where fusion rates are already very high, any new product only adds value if (1) the product is less expensive than what is currently used or (2) clinical outcomes are improved.
The cost of 1 cm3 of Osteocel is approximately $600. Although the cost of cervical PEEK implants vary by institution and manufacturer, the average list price is $2018 (Nuvasive CoRoent, Stryker AVS AS, Depuy Bengal, Medtronic Cornerstone PEEK) bringing the total cost of the construct to $2618. The average cost of a structural cervical cortical cancellous allograft is $1663 (Nuvasive Triad CC, Stryker Bio AVS, Depuy VG-2, Medtronic Cornerstone). Therefore, the cost of using Osteocel in PEEK is approximately $1000 more than that using a structural allograft. With this information, one has to ask whether any biologic that is combined with a synthetic cage adds additional value in the setting of an ACDF. We implore surgeons to take note of the overall cost of all spinal procedures and question when the addition of a bone graft extender or cage adds value when a structural allograft alone may suffice. We look forward to the results of Osteocel in the lumbar interbody and posterolateral space where obtaining fusion is significantly more challenging than that in the cervical spine. If Osteocel can demonstrate increased fusion rates in the lumbar spine, there would be significant value added because the increased cost of the procedure will be offset by its increased clinical success.
From the *Mt. Tam Orthopaedics and Spine Center, Kentfield, CA; and †The Rothman Institute, Thomas Jefferson University, Philadelphia, PA. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Brian W. Su, MD, Mt. Tam Orthopaedics and Spine Center, Attending Spine Surgeon, 640 Goodhill Rd, Kentfield, CA 94904; E-mail: [email protected] DOI: 10.1097/BRS.0000000000000586
E1338
www.spinejournal.com
October 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. SPINE131267POV_LR E1338
14/09/14 1:29 PM
SURGERY
Point of View Brian W. Su, MD,* and Alexander R. Vaccaro, MD, PhD†
O
steocel is minimally manipulated tissue that contains mesenchymal stem cells. It is not known how many of the cells are retained locally and how many differentiate into bone-producing cells. Despite its widespread use, there have been few studies that critically document its success in obtaining fusion (computed tomography grading) in any part of the spine. This study provides the readership with the first prospective study using Osteocel in an anterior cervical discectomy and fusion (ACDF). At 2 years, 92% of singlelevel ACDFs demonstrated successful fusion. Although this study did not include a control group, based on the ACDF arm of the cervical disc replacement studies, Osteocel in polyetheretherketone (PEEK) clearly compares favorably with the structural allograft use. The question, however, goes beyond the effectiveness of Osteocel in assisting fusion in the spine. It really is whether Osteocel in a PEEK spacer adds value to an ACDF. Value is defined as the cost of the intervention versus the quality of outcome over time. In an operation where fusion rates are already very high, any new product only adds value if (1) the product is less expensive than what is currently used or (2) clinical outcomes are improved.
The cost of 1 cm3 of Osteocel is approximately $600. Although the cost of cervical PEEK implants vary by institution and manufacturer, the average list price is $2018 (Nuvasive CoRoent, Stryker AVS AS, Depuy Bengal, Medtronic Cornerstone PEEK) bringing the total cost of the construct to $2618. The average cost of a structural cervical cortical cancellous allograft is $1663 (Nuvasive Triad CC, Stryker Bio AVS, Depuy VG-2, Medtronic Cornerstone). Therefore, the cost of using Osteocel in PEEK is approximately $1000 more than that using a structural allograft. With this information, one has to ask whether any biologic that is combined with a synthetic cage adds additional value in the setting of an ACDF. We implore surgeons to take note of the overall cost of all spinal procedures and question when the addition of a bone graft extender or cage adds value when a structural allograft alone may suffice. We look forward to the results of Osteocel in the lumbar interbody and posterolateral space where obtaining fusion is significantly more challenging than that in the cervical spine. If Osteocel can demonstrate increased fusion rates in the lumbar spine, there would be significant value added because the increased cost of the procedure will be offset by its increased clinical success.
From the *Mt. Tam Orthopaedics and Spine Center, Kentfield, CA; and †The Rothman Institute, Thomas Jefferson University, Philadelphia, PA. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Brian W. Su, MD, Mt. Tam Orthopaedics and Spine Center, Attending Spine Surgeon, 640 Goodhill Rd, Kentfield, CA 94904; E-mail: [email protected] DOI: 10.1097/BRS.0000000000000586
E1338
www.spinejournal.com
October 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. SPINE131267POV_LR E1338
14/09/14 1:29 PM
