Lumbar total disc replacement. Surgical technique.
BACKGROUND
Symptomatic lumbar degenerative disc disease is a challenging entity to treat. The results of arthrodesis may be compromised in the short term by pseudarthrosis and in the long term by pain at the iliac-crest donor site and by junctional degeneration. Total disc replacement has the potential to provide long-lasting relief to these patients. The purpose of this study was to present the clinical and radiographic results assessed seven to eleven years following a Prodisc total lumbar disc replacement.


METHODS
Sixty-four patients had single or multiple-level implantation of a total lumbar disc replacement between 1990 and 1993. The mean duration of follow-up was 8.7 years. Clinical results were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and post-operative radiographs were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and post-operative radiographs were evaluated as well. Subgroup analysis was performed to determine if gender, an age of less than forty-five years, previous surgery, or multilevel surgery had an effect on outcome.


RESULTS
At an average of 8.7 years post-operatively, there were significant improvements in the backpain, radiculopathy, disability, and modified Stauffer-Coventry scores. Thirty-three of the fifty-five patients with sufficient follow-up had an excellent result, eight had a good result, and fourteen had a poor result. Neither gender nor multilevel surgery affected outcome. An age of less than forty-five years and prior lumbar surgery had small but significant negative effects on outcome. Radiographs did not demonstrate loosening, migration, or mechanical failure in any patient. Five patients had approach-related complications.


CONCLUSIONS
The Prodisc lumbar total disc replacement appears to be effective and safe for the treatment of symptomatic degenerative disc disease. Gender and multilevel surgery did not affect the outcomes, whereas prior lumbar surgery or an age of less than forty-five years was associated with slightly worse outcomes. Longer follow-up of this cohort of patients and randomized trials comparing disc replacement with arthrodesis are needed.
Tropiano
Patrick
P
Department of Orthopaedic Surgery, Clinique du Parc, Castelnau-le-Lez, France. ptropiano@ap-hm.fr
Huang
Russel C
RC
Girardi
Federico P
FP
Cammisa
Frank P
FP
Marnay
Thierry
T
D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods*; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011474:Prosthesis Design; D011859:Radiography; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
D020959:Polyethylene