Long-term results of one-level lumbar arthroplasty: minimum 10-year follow-up of the CHARITE artificial disc in 106 patients.
METHODS
A retrospective chart and radiographic review.


OBJECTIVE
To determine the long-term clinical results, radiographic results, and incidence of complications in a large patient cohort with one-level lumbar total disc replacement (TDR).


BACKGROUND
Prior authors have described short-term, mid-term, and long-term clinical and radiographic results in patients with lumbar TDR with highly variable results.


METHODS
From January 1989 to November 1995, 108 patients, with a mean age of 36.4 years, underwent lumbar TDR with the CHARITE Artificial Disc, with 106 available for follow-up. A modified Stauffer-Coventry scale was used to determine clinical outcome. Return to work, work level, and the incidence of complications were assessed. Dynamic lateral flexion-extension and lateral bending radiographs were performed and segmental range of motion (ROM) was measured using the Cobb method.


RESULTS
Mean follow-up time was 13.2 years (range, 10-16.8 years). Of the 106 patients, 87 (82.1%) had either an excellent or good clinical outcome. Of the 96 patients working before surgery, 86 returned to work (89.6%), including 77.8% of patients with hard labor level employment (28 of 36) returning to the same level of work. The mean ROM in flexion-extension was 10.1 degrees , in lateral bending it was 4.4 degrees , and 90.6% of implanted prostheses were still mobile. Eight patients (7.5%) required posterior instrumented fusion. There were 5 cases (4.6%) of postoperative facet arthrosis, 3 cases (2.8%) of subsidence, 3 cases (2.8%) of adjacent-level disease, and 2 cases (1.9%) of core subluxation.


CONCLUSIONS
This retrospective study demonstrates the safety and efficacy of the CHARITE Artificial Disc at one level, either L4-L5 or L5-S1, in the long-term. Clinical outcomes and the rate of return to work were excellent overall. The rate of adjacent-level disease requiring surgical intervention was considerably lower (2.8%) compared with reports in the literature for lumbar fusion. As with any surgical procedure, proper indications play a pivotal role in clinical success.
David
Thierry
T
Polyclinique de Bois-Bernard, Bois-Bernard, France. t.david@voila.fr
D000328:Adult; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014938:Work Capacity Evaluation