title: Degenerative changes of discs and facet joints in lumbar total disc replacement using ProDisc II: minimum two-year follow-up.
abstract: METHODS
  A retrospective clinical and radiologic data analysis.
  
  
  OBJECTIVE
  To determine the radiologic changes in the discs at the adjacent levels and facets at the index and adjacent levels after total disc replacement (TDR) using ProDisc II in a minimum 2-year follow-up.
  
  
  BACKGROUND
  The main purposes of TDR are to preserve the physiologic segmental motion at index level, and to prevent accelerated degeneration at the index and adjacent segments. However, there are few reports dealing with the effects of TDR on the degenerative changes in a long-term follow-up.
  
  
  METHODS
  After TDR using ProDisc II, the degree of disc and facets degeneration at the index and adjacent levels was assessed by observing lumbar magnetic resonance imaging (MRI) and computed tomography (CT) images before surgery and at minimum 26 months after operations. The degenerative changes of the discs and facets were determined in relation to the clinical outcome, various perioperative factors, and prosthesis factors.
  
  
  RESULTS
  Thirty-two patients with 41 TDR included in this investigation. The progression of facets degeneration (PFA) was observed in 12 of 41 TDR levels. Among 47 adjacent segments, the progression of disc degeneration and PFA were observed in 2 levels (4.3%), and 3 levels (6.4%), respectively. All cases of PFA occurred only in those with preoperative degeneration of grade 1. PFA at the index segments was positively related with female in gender (P = 0.008), the malposition of prosthesis on frontal plane (P = 0.025), and 2-level TDR in the number of TDR level (P = 0.008).
  
  
  CONCLUSIONS
  After TDR using ProDisc II, the degenerative changes in the discs and facets at the adjacent segments appeared to be minimal. However, in 29.3% of the TDR segments, the facet joints presented PFA, which was more common in female, malposition of prosthesis on frontal plane, and 2-level TDR in a minimum 2-year follow-up.
authors.affiliation: Department of Neurosurgery and daggerRadiology, Kang Nam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. ckpmd@catholic.ac.kr
authors.forename: Chun-Kun
authors.initials: CK
authors.lastname: Park
authors.forename: Kyeong-Sik
authors.initials: KS
authors.lastname: Ryu
authors.forename: Won-Hee
authors.initials: WH
authors.lastname: Jee
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D021801:Zygapophyseal Joint / Q000473:pathology / Q000601:surgery*