title: Analysis of adjacent segment reoperation after lumbar total disc replacement.
abstract: BACKGROUND
  Fusion has long been used for treating chronic back pain unresponsive to nonoperative care. However, potential development of adjacent segment degeneration resulting in reoperation is a concern. Total disc replacement (TDR) has been proposed as a method for addressing back pain and preventing or reducing adjacent segment degeneration. The purpose of the study was to determine the reoperation rate at the segment adjacent to a level implanted with a lumbar TDR and to analyze the pre-TDR condition of the adjacent segment.
  
  
  METHODS
  This study was based on a retrospective review of charts and radiographs from a consecutive series of 1000 TDR patients to identify those who underwent reoperation because of adjacent segment degeneration. Some of the patients were part of randomized studies comparing TDR with fusion. Adjacent segment reoperation data were also collected from 67 patients who were randomized to fusion in those studies. The condition of the adjacent segment before the index surgery was compared with its condition before reoperation based on radiographs, magnetic resonance imaging (MRI), and computed tomography.
  
  
  RESULTS
  Of the 1000 TDR patients, 20 (2.0%) underwent reoperation. The mean length of time from arthroplasty to reoperation was 28.3 months (range, 0.5-85 months). Of the adjacent segments evaluated on preoperative MRI, 38.8% were normal, 38.8% were moderately diseased, and 22.2% were classified as having severe degeneration. None of these levels had a different grading at the time of reoperation compared with the pre-TDR MRI study. Reoperation for adjacent segment degeneration was performed in 4.5% of the fusion patients.
  
  
  CONCLUSIONS
  The 2.0% rate of adjacent segment degeneration resulting in reoperation in this study is similar to the 2.0% to 2.8% range in other studies and lower than the published rates of 7% to 18% after lumbar fusion. By carefully assessing the presence of pre-existing degenerative changes before performing arthroplasty, this rate may be reduced even more.
authors.affiliation: Texas Back Institute Research Foundation, Plano, TX.
authors.forename: Scott
authors.initials: S
authors.lastname: Rainey
authors.affiliation: Texas Back Institute, Plano, TX.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Blumenthal
authors.affiliation: Texas Back Institute, Plano, TX.
authors.forename: Jack E
authors.initials: JE
authors.lastname: Zigler
authors.affiliation: Texas Back Institute, Plano, TX.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Guyer
authors.affiliation: Texas Back Institute Research Foundation, Plano, TX.
authors.forename: Donna D
authors.initials: DD
authors.lastname: Ohnmeiss
keywords: Adjacent segment degeneration; Lumbar spine; Total disc replacement