title: Application of Laparoscopic Lumbar Discectomy and Artificial Disc Replacement: At Least Two Years of Follow-Up.
abstract: METHODS
  This prospective observational study included 22 patients who were diagnosed with symptomatic degenerative disc disease treated via artificial disc replacement (ADR) with a laparoscopic technique.
  
  
  OBJECTIVE
  The current study aimed to assess the safety and efficacy of ADR using a laparoscopic technique for lumbar disc herniation.
  
  
  BACKGROUND
  Symptomatic degenerative disc disease is the major cause of low back pain with lumbar segmental instability. ADR has increased in popularity as an alternative treatment for lumbar disc herniation. However, the traditional approach to spinal surgery carries the risk of catastrophic bleeding from injury to major vessels, as well as iatrogenic injury to the viscera and associated structures. Therefore, laparoscopic lumbar discectomy and ADR may represent a useful alternative.
  
  
  METHODS
  Twenty-two patients (8 males and 14 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Seven cases involved the L4/5 level, and 15 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. Three-dimensional computed tomographic angiography (3D-CTA) of the iliac great blood vessels was completed before the surgery. All surgical procedures were performed under a laparoscope. All patients were followed up.
  
  
  RESULTS
  All surgeries were successfully completed. The average operation time was 120 minutes (range 110-150 min), and the average hemorrhage was 145 mL (range 80-360 mL). All cases underwent X-rays at 3 days, 3 months, 6 months, 1 year, and the final postoperative follow-up. The outcome indicated that there was no mobilization, displacement, or subsidence in all patients with the exception of one case with prosthesis migration. The follow-up time was 43.8 months (range 24-64 months). The mean visual analog scale (VAS) and Oswestry scores were decreased postoperatively. The mean improvement rate of the VAS score was 73.5%.
  
  
  CONCLUSIONS
  Lumbar ADR using a laparoscope represents a novel, minimally invasive treatment for symptomatic degenerative disc disease and severe lumbar discogenic pain.
authors.affiliation: *Department of Spinal Surgery, the First Affiliated Hospital of University of South China, Hengyang, HuNan Province, China †The Orthopaedic Department of Sun YiXian Hospital of Zhongshan University, Guangzhou, Guangdong Province, China.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Wang
authors.forename: Shangli
authors.initials: S
authors.lastname: Liu
authors.forename: Gengsheng
authors.initials: G
authors.lastname: He
authors.forename: Yiguo
authors.initials: Y
authors.lastname: Yan
authors.forename: Xuelin
authors.initials: X
authors.lastname: Li
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Ouyang
authors.forename: Jianhong
authors.initials: J
authors.lastname: Zuo