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Two-Level Artificial Disc Replacement in ASCs: Dr. Jeffrey Nees

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Jeffrey NeesEarlier this month, Jeffrey Nees, MD, became the first spine surgeon in the Oklahoma City area to perform a two-level artificial disc replacement at an ambulatory surgery center.

Artificial disc replacements — once thought an experimental procedure — are now gaining coverage and reimbursement from insurance companies and Dr. Nees has been able to bring them to an outpatient setting.

"When they first came out we had high hopes and expectations that disc replacements would surpass fusions in efficacy," says Dr. Nees a neurosurgeon at Laser Spine Institute's Oklahoma City facility. "That's difficult because fusions have been so successful in the short term for pain relief. We didn't see an advantage for disc replacements in the short term — they had the same efficacy — but over time there was less stress on nearby discs resulting in fewer reoperations for adjacent segment disease."

Dr. Nees used LDR's Mobi-C artificial disc, the only artificial disc approved for both one- and two-level disc replacements in the United States.

"Now with the FDA approval for two-level disc replacements, it opens up more options to the surgeons," says Dr. Nees. "If you have a patient coming to the clinic with two-level disease, you can use the Mobi-C or do fusion. Before you could only do fusions for both levels. This opens a significant door for us and it's very advantageous for patients."

Motion-sparing design
Artificial disc replacements are considered motion-sparing technology because they are designed to more naturally mimic the patient's anatomy. Despite the clinical advantages, incorporating the procedure into practice is just a small variation of fusion operations that most spine surgeons have been performing for decades.

"I hope more surgeons will use this motion-sparing technology because it  simulates a more natural cure for the spine rather than something extremely artificial that essentially fuses bones together," says Dr. Nees. "The Mobi-C design itself incorporates the best of all worlds as far as design. Some preceding designs in artificial discs have a flange on the front sticking over the vertebral bodies, and in that situation you couldn't put a second disc in because it wouldn't fit. The Mobi-C has a zero profile design so there is nothing sticking out in front. It's also metal-on-plastic instead of metal-on-metal, so there isn't the worry about the metal ions leeching into the patient's body."

The Mobi-C disc also incorporates a shifting axis of rotation to duplicate the patient's natural physiology.

Outpatient procedure
To bring this procedure into the outpatient setting, Dr. Nees and his team place a drain in the patient and send a medical healthcare professional home with the patient for the first 23 hours.

"The one thing that could really get patients in trouble is the hematoma development," says Dr. Nees. "It's dramatic and could get patients in trouble very quickly, but the risk of hematoma development is reduced to almost zero when you leave the drain in. The patient comes back in a few days and I remove it."

Implant costs are also a huge issue for ASCs, being one of the biggest case expenses. Laser Spine Institute works closely with disc vendors to ensure they are affordable and company representatives are available in the operating room to assist if necessary. To reduce additional costs, the ASC ensures efficiency by assigning the same team to work with Dr. Nees on every case.

"We have a team that's dedicated to these procedures so they are as streamlined as possible," he says. "That's a key to the success of these operations and has made it feasible in the outpatient setting."

While Dr. Nees is among the first to do these procedures in an ASC, Laser Spine Institute is no stranger to new procedure development. The practice is constantly expanding the spectrum of care and expertise for minimally invasive outpatient procedures.

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