title: Index level mobility after total lumbar disc replacement: is it beneficial or detrimental?
abstract: METHODS
  Analysis of segmental and total lumbar range of motion (ROM) before and after total lumbar disc replacement.
  
  
  OBJECTIVE
  To examine the relationship between absolute segmental and total lumbar ROM and evolution of ROM on clinical outcome.
  
  
  BACKGROUND
  At the moment, data are scarce with regard to the evolution of total lumbar ROM (t-ROM) and segmental ROM (s-ROM) after total lumbar disc replacement. Moreover, the influence of ROM on clinical outcome still is unclear and remains a matter of controversial debate. METHODS.: Forty patients operated on for mono- or bisegmental symptomatic degenerative disc disease with a total of 45 artificial discs (ProDisc-L, Synthes) were analyzed. Pre- and postoperative s-ROM and t-ROM were measured on flexion/extension radiographs. The Oswestry Low Back Pain Disability Questionnaire and the Short Form 36 Health Survey were obtained pre- and postoperatively with a minimum follow-up of 3 years (37-64 months).
  
  
  RESULTS
  Neither the s-ROM (pre-/postoperatively: 6.9 degrees/7.3 degrees) nor the t-ROM (pre-/postoperatively: 34.9 degrees/35.8 degrees) did change significantly after implantation of an artificial disc. Postoperatively, there was an increase of s-ROM (t-ROM) in 40% (40%), a decrease in 35% (30%), and no change in 25% (30%) of the patients. A significant inferior clinical outcome only was observed in patients with decreased t-ROM. The resulting postoperatively s-ROM had no significant impact on outcome.
  
  
  CONCLUSIONS
  Neither the absolute s-ROM nor the evolution of s-ROM (increase, decrease, unchanged) was positively correlated with better clinical outcome. Although a positive correlation was observed with regard to t-ROM.
authors.affiliation: Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany. balkan.cakir@rku.de
authors.forename: Balkan
authors.initials: B
authors.lastname: Cakir
authors.forename: René
authors.initials: R
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Mattes
authors.forename: Christian R
authors.initials: CR
authors.lastname: Fraitzl
authors.forename: Heiko
authors.initials: H
authors.lastname: Reichel
authors.forename: Wolfram
authors.initials: W
authors.lastname: Käfer
mesh_terms: D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019736:Prostheses and Implants; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D016896:Treatment Outcome