[Current short- and long-term results of lumbar disc replacement : update 2008].
Lumbar total disc replacement is an increasingly common way of treating degenerative lumbar disc disease while preserving mobility. The aim of this analysis was to survey evidence-based data to classify the procedure. Based on a MEDLINE inquiry, 38 clinical trials dealing with lumbar total disc replacement were selected and analyzed by the criteria of indication, preoperative procedure, and clinical follow-up. These data represent 3,180 patient-related evaluations with follow-up of 5.9 to 204 months. We also included ten retrospective studies. Patient satisfaction was a mean of 90.73%, and the Oswestry Disability Index and Visual Analog Scale were significantly lower. High rates of revision surgery, explantation surgery, and secondary fusions are linked to wrong preoperative indication. According to evidence criteria, the results show that lumbar total disc replacement is a safe procedure with a high rate of success. There is clear evidence that both imprecise indication and the choice of too-small implants significantly reduce the prospect of surgical success and increase the rates of reintervention.
Wiedenhöfer
B
B
Abteilung Orthopädie II, Stiftung Orthopädische Universitätsklinik Heidelberg, 69118, Heidelberg, Deutschland. bernd.wiedenhoefer@ok.uni-heidelberg.de
Ewerbeck
V
V
Suda
A J
AJ
Carstens
C
C
D019643:Arthroplasty, Replacement / Q000295:instrumentation*; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D015337:Multicenter Studies as Topic; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D055009:Spondylosis / Q000601:surgery*