Abstract
Retrospective case series study. To assess the effectiveness of activ L total disc replacement (TDR) on degenerative disc diseases with the clinical and radiographical results. There are few reports on activ L TDR. This is the first one from China. From March 2009 to March 2012, 32 patients with degenerative disc diseases underwent mono- or bisegmental lumbar TDR. Mean age was 45.1 years (32-58 yr). Clinical outcomes were measured by Oswestry Disability Index and Visual analogue scale pre- and postoperatively (1, 2, and 3 yr). Radiographical parameters as range of motion and intervertebral disc height of the index- and adjacent segments were also measured. Prosthesis subsidence and heterotopic ossification were observed during the follow-up period. Work status was also tracked. Thirty patients were available for a mean follow-up of 28.8 months and had complete radiographical data. At the final follow-up, the success rate was 86.7%. Visual analogue scale score for low back pain and leg pain, and Oswestry Disability Index scores significantly improved after surgery. Average intervertebral disc heights of patients with more than 3 years' follow-up at the index segment and upper and lower adjacent segments were 12.87 mm, 12.61 mm, and 11.62 mm, respectively, showing no significant difference compared with preoperative scores. The range of motion of the index and upper adjacent segments showed a significant increase for patients with more than 3 years' follow-up. Changes of range of motion at lower adjacent segment were not significant. We observed tears of the iliac vein in 2 patients, prosthesis subsidence in 3 patients, and heterotopic ossification in 1 patient. At the final follow-up, 18 patients went back to their original work, 8 patients changed jobs, and 4 patients stopped working. The 1- to 3-year follow-up of this cohort of patients showed satisfactory clinical outcomes. The long-term results of activ L TDR need more investigation. 2.
Highlights
The effectiveness of lumbar total disc replacement (TDR) with different prostheses for sagittal alignment has been reported previously
Siepeet al.[5] have prospectively analyzed the clinical efficacy of TDR with ProDisc II (DePuySynthes Inc., West Chester, PA, USA), and the results revealed satisfactory and maintained mid- to long-term clinical outcomes after a mean follow-up of 7.4 years
KG, Tuttlingen, Germany) used in this study involves a modular design, offering the lowest profile of 8.5 mm. This prosthesis is a metal-on-plastic device, with three modular components: inferior and superior cobaltchrome-molybdenum plates with either a large central keel or anterior spikes, and an ultrahigh molecular weight polyethylene (UHMWPE) inlay lying inside the inferior plate, which was similar to the Prodisc-L (DePuySynthes Inc.)
Summary
The effectiveness of lumbar total disc replacement (TDR) with different prostheses for sagittal alignment has been reported previously. For over the past few years, spinal fusion has been regarded as the standard surgical treatment for painful lumbar degenerative disc disease (DDD) due to failed conservative treatments This approach eliminates the motion of the index segment, creates abnormal biomechanical conditions that might lead to the degeneration of adjacent segments, and requiring subsequent reoperation.[1, 2] To overcome this problem, nonfusion technologies have been developed, such as total disc replacement (TDR), and this is one of the alternate methods that can restore and maintain normal segmental motion without affecting any adjacent segments. The other fundamental theoretical advantage of TDR is that it assists in restoring or maintaining the sagittal balance of the spine.[3, 4] These advantages of TDR might be the main reasons for the achievement of good clinical outcomes. Putzier et al.[9] have reported that long-term results of TDR implantation in DDD are at least as good as fusion results is still lacking
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