Clinical StudiesRange of motion and adjacent level degeneration after lumbar total disc replacement
Introduction
The fundamental rationale for performing total disc replacement (TDR) instead of fusion is preservation of motion. Theoretically, preservation of segmental motion may prevent the development of adjacent level degeneration (ALD) seen in long-term follow-up of fusions. No Class I or II data are currently available to support or refute this theory. It has been shown that some patients with lumbar TDR retain significant motion at short and midterm follow-up [1], [2], [3], [4], [5], [6]. Furthermore, low TDR range of motion (ROM) is statistically associated with the development of radiographic ALD [6]. However, we are not aware of any published data that quantify the relationship between motion preservation and the development of ALD.
Because new technologies bring with them new potential complications [7], the task of weighing the risk/benefit profile of TDR is difficult. Until long-term data from randomized controlled trials of TDR versus fusion are available, the theory that motion preservation reduces ALD will remain unproven. However, retrospective studies may provide important preliminary information to clinicians. The purpose of this study is to examine the relationship between ROM and the development of ALD 7 to 11 years after TDR. Finally, the clinical impact of radiographic ALD after TDR is examined.
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Patients
From March 1990 to September 1993, 93 Prodisc (Aesculap AG & Co., Tuttlingen, Germany) total disc prostheses were implanted in 64 patients by a single surgeon (TM) at the Clinique du Parc (Castelnau-le-Lez, France). The indication for surgery was disc degeneration with discogenic back pain that had failed at least 6 months of nonsurgical management including anti-inflammatory medications, activity modification, and physical therapy. Diagnosis was based upon plain radiographs, magnetic resonance
Results
Of the 42 patients evaluated, 10 patients (24%) with radiographic ALD were identified. Four patients had loss of disc space height, three had anterior osteophyte formation, and three had both height loss and osteophyte formation. None had static or dynamic listhesis of greater than 3.5 mm. The mean ROM measured at all levels was 3.8°±2.0° (range 0–18). The patients with ALD had a ROM of 1.6°±1.3° (range 0–4) whereas the patients without ALD had ROM 4.7°±4.5° (range 0–18, p<.035).
A clear
Discussion
These data demonstrate that at mean 8.7-year follow-up, the prevalence of ALD after TDR is higher in patients with less ROM. The prevalence of ALD was statistically lower in patients with flexion-extension motion of at least 5°. In our patients, ROM less than 5° was necessary but not sufficient for the development of ALD because 59% of patients without ALD had ROM less than 5°. We are aware of no studies in the current literature that closely address the relationship between TDR ROM and
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2020, Journal of the Mechanical Behavior of Biomedical MaterialsCitation Excerpt :Interbody fusion cages make up over half of the total market size and are the most established method for treating disc degeneration; however, these procedures have a high complication rate (36.4%) and often require revision surgery (Chrastil and Patel, 2012). This procedure typically results in a significant reduction in pain at the cost of limited mobility (Huang et al., 2006) and adjacent level disease (Kim et al., 2012; Verma et al., 2013). Alternatively, a total intervertebral disc replacement (TDR) may be implanted in lieu of a fusion procedure such that maximum mobility and comfort are retained.
FDA device/drug status: not applicable.
Authors acknowledge financial relationships (TM inventor of the Prodisc 1 TDR implant, and consultant and stockholder for Spine Solutions, Inc.; FPG and FPC consultants and stockholders for Spine Solutions, Inc.) which may indirectly relate to the subject of this manuscript.