Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2008 Oct;43(5):579-587. Korean.
    Published online Oct 31, 2008.
    https://doi.org/10.4055/jkoa.2008.43.5.579
    Copyright © 2008 The Korean Orthopaedic Association
    Original Article

    Factors Affecting Segmental Motion of Lumbar Total Disc Replacement

    Sung Soo Chung, M.D., Chong Suh Lee, M.D., Sung Woo Choi, M.D., Jae Wook Yu, M.D. and Jong Won Kwon, M.D.*
      • Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
      • *Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    • Address reprint requests to Sung-Woo Choi, M.D. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82.2-3410-3509, Fax: +82.2-3410-0061, Email: osfracture@naver.com

    Abstract

    Purpose

    To assess factors significantly affecting the range of motion of the lumbar spine at the operated segment following total disc replacement (TDR) arthroplasty.

    Materials and Methods

    Thirty-six patients (15 men and 21 women) who received lumbar TDR at a single level using Prodisc II (Spine Solutions Inc, New York, NY USA) were included in this study. The study included 23 cases at L4-5 and 13 cases at L5-S1. The average patient age was 43.6 years (range, 23-59 years) and the minimum follow-up was 24 months (range, 24-61 months). Two independent observers measured radiological parameters preoperatively, at 3 months postoperatively, and at the final follow-up. These parameters included disc height, affected level segmental range of motion (ROM) and prosthesis position and height. A radiologist independently measured facet joint degeneration and the fat contents of the paraspinal muscles on preoperative MR images. Clinical results were evaluated using the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS).

    Results

    Segmental ROM was well preserved at the final follow-up (preoperative, 11.3 degrees; 3 months postoperative 13.2 degrees; final follow up, 13.1 degrees). The factors found to affect segmental ROM significantly at the final follow-up were the preoperative ROM, preoperative disc height, disc height increment ratio and a history of previous back surgery on the affected disc (p<0.05). The VAS significantly improved in patients with increased segmental ROM at the operated level (p<0.05).

    Conclusion

    Statistical analysis showed that the factors affecting segmental ROM were the preoperative ROM, preoperative disc height, disc height increment ratio, and a history of previous back surgery on the affected disc. However, further effort needs to be directed towards an evaluation of a larger number of patients with a longer follow-up.

    Keywords
    Lumbar total disc replacement; Range of Motion; Disc height

    Figures

    Fig. 1
    Flexion-extension radiographs of a patient who underwent TDR implantation at L4-L5. The TDR ROM was measured using the Cobb method with the keels as radiographic landmarks in flexion and extension X-rays.

    Fig. 2
    Muscle fatty degeneration grade 2, right facet joint degeneration grade 1 and left grade 3.

    Fig. 3
    Lateral flexion (A) and extension (B) radiographs at 4-years of a 40-year-old woman with the Prodisc II applied to L5-S1. Segmental ROM was 18°. Lumbarization of S1.

    Tables

    Table 1
    (A) Grading of the Lumbar Facet Joint Degeneration Using Computed Tomography and Magnetic Resonance Imaging, as Described by Weishaupt et al. (B) Fat Content of the Lumbar Paraspinal Muscle, as Described by Goutallier et al.

    Table 2
    Prosthesis Position as Described by McAfee et al. (A), and Le Huec et al. (B)

    Table 3
    Summary of the Profiles (Categorical Variables)

    Table 4
    Summary of Profiles (Continuous Variables)

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    MeSH Terms
    Follow-Up Studies
    Humans
    Male
    Muscles
    New York
    Prostheses and Implants
    Range of Motion, Articular
    Spine
    Total Disc Replacement
    Zygapophyseal Joint
    Metrics
    Share
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    Tables
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