Total lumbar disc replacement in treating degenerative disc disease / 中华骨科杂志

ABSTRACT

Objective To evaluate the effect of total lumbar disc replacement (TLDR) for treatment of lumbar degenerative disc disease (DDD). Methods The symptomatic 90 patients with DDD underwent single or multiple-level implantation of TLDR with Prodisc L prosthesis (48 levels) and Maverick prosthesis (60 levels). The conservative treatment failed to improve the symptoms in all patients after six months. The average age of the patients was 39.2 years (range 25-54 years). There were 62 females and 28 males. A total of 108 prostheses were implanted encompassing one and three levels. 85 patients were operated at one level, 10 patients at two levels, and 1 patient at three levels. Anterior retroperitoneal approach was performed at all cases. Subjective evaluation was performed according to Odom's criteria, Oswestry disability scale and visual analog scale (VAS) as well as radiographic assessment. Results The operating time varied between 75 and 160 minutes, mean 115.5 minutes. A venous laceration was found in 1 patient during exposure, but the laceration was repaired and the procedure was completed. The follow-up period ranged from 12 months for 90 patients. The visiting of the follow up was fixed at 4, 6, 26, 52 weeks postoperatively. In 76 of the patients excellent results were observed, and good results were recorded in 10 patients. Fair results were seen in 4 patients. The mean hospital stay was 3.4 days. Clinical outcome was reflected by a decrease from 8.3 to 3.1 pre- and postoperatively in the VAS. In one patient with double-level prosthesis developed deep vein thrombosis (DVT), 2 patients developed mild subsidence of Prodisc L prosthesis at L5S1A (1 level) and L4-5, L5S1A (2 levels), revision surgeries were performed by additional procedure of vertebralplasty in the 2 patients at 7th months during follow-up period. Conclusion The favorable preliminary results suggest that TIDR might be function as a physiologic replacement for degenerated lumbar intervertebral disc. The goals of TLDR include relieving discogenic pain, restoring disc height, foraminal height, and spinal alignment. An ideal TLDR would eliminate the risk of pseudarthrosis and possibly reduce adjacent-level degeneration. Additional benefits include shorter hospital stays and earlier return to work.