title: Five-year results of lumbar disc prostheses in the SWISSspine registry.
abstract: OBJECTIVE
  The Swiss Federal Office of Public Health demanded a nationwide HTA registry for lumbar total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISS spine registry is to generate evidence about the safety and efficiency of lumbar TDA.
  
  
  METHODS
  Two hundred forty-eight cases treated between 3-2005 and 6-2006, who were eligible for the 5-year follow-up were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 85.9, 77.0, 44.0 and 51.2 %, respectively. Outcome measures were back and leg pain, medication consumption, quality of life, intraoperative and postoperative complication and revision rates. Additionally, segmental mobility, ossification, adjacent and distant segment degeneration were analysed at the 5-year follow-up.
  
  
  RESULTS
  There was a significant, clinically relevant and lasting reduction of back (preop/postop 73/29 VAS points) and leg pain (preop/postop VAS 55/22) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.30/0.76 EQ-5D score points) until 5 years after surgery. The rates for intraoperative and early postoperative complications were 4.4 and 3.2 %, respectively. The overall complication rate during five postoperative years was 23.4 %, and the adjacent segment degeneration rate was 10.7 %. In 4.4 % of patients, a revision surgery was performed. Cumulative survivorship probability for a revision/re-intervention-free 5-year postoperative course was 90.4 %. At the 5-year follow-up, the average range of motion of the mobile segments (86.8 %) was 9.7°. In 43.9 % of patients, osteophytes at least potentially affecting the range of motion were seen.
  
  
  CONCLUSIONS
  Lumbar TDA appeared as efficient in long-term pain alleviation, consequent reduction of pain medication consumption and improvement of quality of life. The procedure also appeared sufficiently safe, but surgeons have to be aware of a list of potential adverse events. The outcome is stable over the 5-year postoperative period. The vast majority of treated segments remained mobile after 5 years, although almost half of patients showed osteophytes.
authors.affiliation: Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014, Bern, Switzerland, emin.aghayev@memcenter.unibe.ch.
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Christian
authors.initials: C
authors.lastname: Etter
authors.forename: Christian
authors.initials: C
authors.lastname: Bärlocher
authors.forename: Friedrich
authors.initials: F
authors.lastname: Sgier
authors.forename: Philippe
authors.initials: P
authors.lastname: Otten
authors.forename: Paul
authors.initials: P
authors.lastname: Heini
authors.forename: Oliver
authors.initials: O
authors.lastname: Hausmann
authors.forename: Gianluca
authors.initials: G
authors.lastname: Maestretti
authors.forename: Martin
authors.initials: M
authors.lastname: Baur
authors.forename: François
authors.initials: F
authors.lastname: Porchet
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Markwalder
authors.forename: Stefan
authors.initials: S
authors.lastname: Schären
authors.forename: Michal
authors.initials: M
authors.lastname: Neukamp
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007595:Joint Prosthesis; D053208:Kaplan-Meier Estimate; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011183:Postoperative Complications / Q000601:surgery / Q000628:therapy; D011788:Quality of Life; D016059:Range of Motion, Articular; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation; D059145:Total Disc Replacement / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult