title: Lumbar total disc arthroplasty utilizing the ProDisc prosthesis in smokers versus nonsmokers: a prospective study with 2-year minimum follow-up.
abstract: METHODS
  Prospective nonrandomized clinical series.
  
  
  OBJECTIVE
  To evaluate the efficacy of ProDisc lumbar artificial disc replacement (ADR) in smokers versus nonsmokers.
  
  
  BACKGROUND
  Smoking is a negative predictor in fusion surgery. To date, a prospective study of the treatment of incapacitating discogenic low back pain using ADR in smokers versus nonsmokers has not been described.
  
  
  METHODS
  A prospective analysis was performed on 104 patients with disabling discogenic low back pain treated with single-level lumbar ProDisc total disc arthroplasty. Smokers and nonsmokers were assessed before surgery and after surgery using patient satisfaction, Oswestry, and Visual Analog Scores. Additionally, preoperative and postoperative neurologic, radiographic, and pain medication assessments were performed at similar postoperative intervals.
  
  
  RESULTS
  Oswestry, Visual Analog Scores, and patient satisfaction scores revealed statistical improvement beginning 3 months after surgery and were maintained at minimum 2-year follow-up. Patient satisfaction scores were higher in smokers (94%) than in nonsmokers (87%) at 2-year follow-up (P = 0.07). Radiographic analysis revealed an affected disc height increase from 4 mm to 13 mm (P < 0.05) and an affected disc motion from 3 degrees to 7 degrees (P < 0.05). No cases of loosening, dislodgment, mechanical failure, infection, or fusion of the affected segment occurred.
  
  
  CONCLUSIONS
  The results of our study indicate that smokers do equally well compared with nonsmokers when ProDisc ADR is used in the treatment of debilitating lumbar spondylosis. Patient outcome and radiographic scores showed significant improvement compared with preoperative levels. Although not evident in our series, additional surveillance for intraoperative and postoperative vascular spasm and occlusion may be warranted in smokers.
authors.affiliation: Department of Orthopaedic Surgery, Spine Center, St. Elizabeth Klinikum, Straubing, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Bertagnoli
authors.forename: James J
authors.initials: JJ
authors.lastname: Yue
authors.forename: Trace
authors.initials: T
authors.lastname: Kershaw
authors.forename: Rahul V
authors.initials: RV
authors.lastname: Shah
authors.forename: Frank
authors.initials: F
authors.lastname: Pfeiffer
authors.forename: Andrea
authors.initials: A
authors.lastname: Fenk-Mayer
authors.forename: Regina
authors.initials: R
authors.lastname: Nanieva
authors.forename: Armin
authors.initials: A
authors.lastname: Karg
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Husted
authors.forename: John W
authors.initials: JW
authors.lastname: Emerson
mesh_terms: D000293:Adolescent; D000328:Adult; D019643:Arthroplasty, Replacement / Q000295:instrumentation* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability; D007595:Joint Prosthesis; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010146:Pain; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome