Acquiring research articles

[jss]

I am so very close to sending in my second appeal to my insurance carrier. I have found cited hoards ADR research papers that contain information and results relevant to my appeal. While I have been able to locate many of these documents on the internet, there are a great many that I've found no other way to acquire than to purchase for $34 each.

Does anyone have any direction on obtaining the following research papers with having to purchase them? There are others I need, but these are a start.

- Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses
- Lumbar disc replacement: 7 to 11-year results with Prodisc (the author is French, and I can read French, so if a French version shows up, that will do fine)
- COMPARISON OF SINGLE LEVEL VERSUS MULTIPLE LEVEL CERVICAL DISC ARTHROPLASTY: 178 CONSECUTIVE PCM PROSTHESES
- ProDisc-L Total Disc Replacement: A Comparison of 1-Level Versus 2-Level Arthroplasty Patients With a Minimum 2-Year Follow-up

Thanks, Jeff

[Harrison]

Jeff, you may already have the abstracts -- but these may be all that you need. You can obtain the full text of the last one, see a few topics down...
_______________________________________

Spine:
20 May 2007 - Volume 32 - Issue 12 - pp 1337-1344
doi: 10.1097/BRS.0b013e318059af12
Cervical Spine
Superiority of Multilevel Cervical Arthroplasty Outcomes Versus Single-Level Outcomes: 229 Consecutive PCM Prostheses
Pimenta, Luiz MD†; McAfee, Paul C. MD*; Cappuccino, Andy MD‡; Cunningham, Bryan W. MSc§; Diaz, Roberto MD†; Coutinho, Etevaldo MD†

Study Design/Setting. Class 2 level of evidence: This is a prospective, consecutive series of 229 prosthetic implantations that were concurrently enrolled between single-level versus multilevel cervical arthroplasty comprising an FDA Pilot Study.

Objective. This study investigated multilevel cervical disc replacement in relation to single-level cervical arthroplasty to find if the same reduction in clinical success would occur with this alternative treatment.

Summary of Background Data. Usually, the clinical outcomes of instrumented cervical fusions deteriorate as the number of vertebral levels of involvement increases.

Methods. A total of 229 patients presented with cervical herniated nucleus pulposus, cervical spondylosis, and/or adjacent segment disease with cervical radiculopathy or myelopathy. Following anterior cervical neurologic decompression seventy-one patients required porous coated motion (PCM) cervical arthroplasties from C3-C4 to C7-T1 (Group S, single level). Sixty-nine patients underwent 158 multilevel PCM cervical arthroplasties (Group M, multilevel) during the same time interval, for the same indications, performed by the same surgeons under the same clinical protocol: double level, 53 cases; three levels, 12 cases: and 4 levels, 4 cases.

Results. The self-assessment outcomes instruments showed significantly more improvement for the multilevel cases. The mean improvement in the NDI for the single cases was 37.6% versus the multilevel cases mean improvement in NDI was 52.6% (P = 0.021). The difference between the two was statistically significant. The mean improvement in the VAS showed the same association: single-level mean improvement 58.4% versus the multilevel cases mean VAS improvement was 65.9%. The Odom's were also more improved for the multilevel versus the single-level group: 93.9% versus 90.5% in the excellent, good, and fair categories. The reoperation rates and serious adverse events were similar between the single-level (S = 3) to the multilevel arthroplasty (M = 2) groups. Kaplan-Meier implant survivorship analysis at 3 years for the cohort of 229 prostheses was 94.5% (confidence interval, 1.00-0.820).

Conclusions. This prospective study of cervical arthroplasty is the first report to date showing significantly improved clinical outcomes for multilevel cervical arthroplasty compared with single-level cervical disc replacement using an FDA validated outcome instrument.

[Harrison]

4:19 Lumbar disc replacement: 7 to 11-year results with Prodisc

Thierry Marnay

Purpose of study: Total disc replacement is a surgical procedure that can be considered as an alternative to spinal fusion, for the treatment of patients with chronic low back pain secondary to degenerative disc disease. Total disc replacement allows pathological disc removal while maintaining or restoring disc height and preserving motion of the involved segment.

Methods used: Prodisc is made up of an inferior and superior titanium plate. Each plate has two notched keels designed to provide mechanical interlocking with the vertebral end plate. The surfaces of the plates in contact with bone are plasma sprayed with titanium allowing the bone ingrowth and providing long-term stability. A convex shape dome of polyethylene inserted in the inferior plate articulates with superior plate and allows motion between the vertebral bodies. Patients enrolled in this study had a history of chronic low back pain and had failed conservative therapy. Patients were clinically evaluated for low back pain and leg pain using a visual analog scale (VAS); neurological examination and the use of pain medication. Patients were interviewed on daily activity, work recovery, sport, and the Oswestry scale and Short Form (SF)-36 were recorded. Preoperative and follow-up Beaujon score, including evaluation of low back pain, leg pain, neurological status, walking capacity, medication and everyday life evaluation, were compared. Radiographs and computed tomography scans were evaluated. Radiographic measurement included height of implant, resorption around the implant, flexion/extension and lateral bending motion and subsidence.

of findings: From 1990 to 1993, 93 prostheses were implanted in 64 patients by anterior approach from L2 to S1: 39 cases, one level; 21 cases, 2 levels; 4 cases 3 levels. To date, no implants have been explanted. Five patients with ongoing pain have been fused by a posterior approach. Radiographically, all implants are stable and show no migration of subsidence. The last follow-up patients were at 8.6 years average of postsurgery. Complications included vascular (1) and sexual temporary dysfunction (2) and were related to the anterior approach. The patients' back pain measured by VAS was on average 8.5 preoperatively and 3.0 at the final follow-up. For leg pain, VAS showed 7.1 preoperatively and 1.9 at the final follow-up. At the long-term follow-up, 65% of the patients reported that they were “entirely satisfied,” 28% “satisfied” and only 7% “not satisfied.” These overall patient satisfaction data were supported by the Oswestry score (average, 8.3) as well as the SF-36 results and Beaujon score (average preoperative 7/20 SD=3, postoperative 16/20 SD=3, relative gain 0.69, SD 0.23).

Relationship between findings and existing knowledge: These results demonstrate that the Prodisc can remain mechanically stable and provide significant pain relief and improvement in functional status while maintaining motion in patients at 7 to 11 years of follow-up. Total disc replacement may represent an option for the surgical treatment of mechanical low back pain secondary to degenerative disc disease that removes the pathological disc but preserves motion. Disc arthroplasty constitutes a promising alternative to fusion.

Overall significance of findings: It may actually be associated with the development of less adjacent disc disease than an arthrodesis because of the preservation of motion. However, further research is necessary, and a prospective, randomized trial is necessary to compare these two techniques for the treatment of degenerative disc disease.

Disclosures: No disclosures.

Conflict of interest: Thierry Marnay, consultant, and stockholder: Spine Solutions Inc.

[Harrison]

Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue SUPP_III, 455-456.

Sydney – 28–30 April, 2006
President – Mr Ian Farey Presidential Guest Lecturer – Alexander R. Vaccaro
COMPARISON OF SINGLE LEVEL VERSUS MULTIPLE LEVEL CERVICAL DISC ARTHROPLASTY: 178 CONSECUTIVE PCM PROSTHESES

L. Pimenta; M. Scott-Young; A. Cappuccino; and P.C. McAfee
Spine and Scoliosis Centre, Towson, USA

Introduction

This is a prospective, consecutive series of 178 prosthetic implantations to analyse single level versus multiple level cervical arthroplasty with two years minimum follow-up

Methods

Fifty-five patients underwent a total of fifty-five Porous Coated Motion (PCM) cervical arthroplasties from C3–4 to C7–T1 (Group S for single level). Fifty-four patients underwent one hundred and nine multilevel PCM cervical arthroplasties (Group M for multilevel) during the same time interval, for the same indications, performed by the same surgeons under the same clinical protocol— double level, 43 cases; three levels, 7 cases: and four levels, 4 cases. Sixteen PCM cases had been performed as complex revision procedures with prior fusions—9 in Group S and 7 in Group M. They included 1 previous Bryan Disc, 1 cage-plate, 1 patient with Klippel-Feil disease, 3 patients had failed lordotic cervical cages. One additional patient in Group M had a fracture-dislocation at C4–5 with a pseudarthrosis at C3–4 and C5–6. The demographics between Group S and Group M were very similar—mean age of patients, gender, severity of neurologic symptoms and distribution of radicular and myeloradicular symptoms.

Results

There were no deaths, no infections, and no instances of iatrogenic neurologic progression in either the single level or the multiple level arthroplasty group. The mean EBL, length of surgery, and length of hospital stay were greater for the Multilevel Group. In contrast to these three operative demographic statistics, the self assessment outcomes instruments consistently showed more improvement for the multilevel cases. The mean improvement in the NDI for the single cases was 54.8 % (+/– 20.9) versus the multilevel cases mean improvement in NDI was 64.8 % (+/– 33.7). The mean improvement in the VAS showed the same relationship—single level mean improvement 62.0 % (26.9) versus the multilevel cases mean VAS improvement was 68.1% (+/– 31.4). The SF-36, Odoms, and TIGT were also more improved for the multilevel versus the single level group. The reoperation rates, adverse events, and incidence of complications were the same between the single level to the multilevel arthroplasty groups.

Discussion

This prospective report of cervical arthroplasty demonstrates that each cervical vertebral level is biomechanically independent of the adjacent level, whether it contains an arthoplasty or an unoperated intervertebral disc. With the Porous Coated Motion cervical arthroplasty the incidence of reoperation did not increase proportionately higher as the number of cervical levels requiring instrumentation increased. Even in three and four level arthroplasty the true benefits of cervical disk replacement outcomes were demonstrated on functional clinical outcomes at minimum two-year follow-up.

The abstracts were prepared by Assoc Prof Bruce McPhee. Correspondence should be addressed to him at the Division of Orthopaedics, The University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, Herston, Brisbane, 4029, Australia.

[Harrison]

The abstract and full article:

ProDisc-L Total Disc Replacement: Comparison of 1- vs. 2-Level Arthroplasty: Results

http://www.medscape.com/viewarticle/563881_3

[jss]

Harrison,

Thanks, and yes, I do have the abstracts. Those are what I used to determine that I wanted the documents. This evening I have managed to run down two of them.

The big one I have left now is the "COMPARISON OF SINGLE LEVEL...". Having exhausted every avenue I can think of, unless I have any other ideas, I'll purchase it this weekend.

Thanks again, Jeff

[annapurna]

If you have time to trade for money savings, you could try hunting down a medical college and photocopying articles in the library. Sometimes it works and sometimes it simply wastes time.

[jss]

You know annapurna, for some reason it NEVER occurred to me to go to the library of a medical school... I know of two medical schools here in the Dallas area. I just may give that a shot this weekend.

Thanks, Jeff

(BTW: I've already traded off about 120 hours working on this appeal; so yes, I'm willing)

[DAnn]

Hi
I am in Dallas too.
20 years ago I had a research job (my first job out of college) in the legal/medical field (a good one for medicine) and there was no internet. I spent many hours at UT Southwestern's library. Hope that works for you.
Just bring cash for parking now and a lot of hand sanitizer!
My two tiwn boys were also a miracle from UT Southwestern.

If you are in Dallas, and a cervical patient, maybe we could share stories.

I'm new to this, but looking in the same area you are. I hope I can help you out...it would be good if we could share. Still doing research, just not medical, but I want to...
DAnn

feel free to email me.

I'm looking to do one level fusion and one level ADR....I love my doctor, just trying to jump through the insurance hoops