title: Clinical outcomes after treatment with disc prostheses in three lumbar segments compared to one- or two segments.
abstract: BACKGROUND
  Fusion surgery in the rare patients suffering from symptomatic degenerative disc disease (DDD) at three segments has been reported to produce poor results and a high frequency of complications, why patients suffering from DDD at three segments are seldom offered surgical treatment.
  
  
  OBJECTIVE
  To compare clinical outcome after one- and two years, between patients that have undergone disc replacement surgery (TDR) at three segments and patients that have been treated at less segments.
  
  
  METHODS
  The present study is based on data recorded in the Swedish Spine Registry (SweSpine). The study group consisted of 30 patients who underwent three-segment TDR, the comparative group of 700 patients treated in one or two segments. Analyses included comparisons of preoperative data, postoperative results and improvement from baseline.
  
  
  RESULTS
  Our results showed no differences in outcome between groups at one- and two years postoperatively. Improvements achieved after surgery in both groups well exceeded established values for minimally clinically important difference (MCID).
  
  
  CONCLUSIONS
  The results of this study show that patients with a diagnosis of therapy-resistant chronic low back pain (CLBP) due to DDD in one, two or even three lumbar segments achieve similar and good results after TDR surgery.
  
  
  CONCLUSIONS
  The rare patients with severe and convincing DDD from three segments might in carefully selected cases be offered surgery, with a reasonable chance of a beneficial outcome.
authors.affiliation: Stockholm Spine Center, Löwenströmska Hospital, Stockholm, Sweden.
authors.forename: Svante
authors.initials: S
authors.lastname: Berg
authors.affiliation: Medical School, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nina
authors.initials: N
authors.lastname: Gillberg-Aronsson
keywords: Low Back Pain; disc degeneration; register study; three segments; total disc replacement; treatment outcome