RESUMO
STUDY DESIGN: Prospective nonrandomized clinical series. OBJECTIVES: To evaluate the efficacy of ProDisc lumbar artificial disc replacement (ADR) in smokers versus nonsmokers. SUMMARY OF BACKGROUND DATA: Smoking is a negative predictor in fusion surgery. To date, a prospective study of the treatment of incapacitating discogenic low back pain using ADR in smokers versus nonsmokers has not been described. METHODS: A prospective analysis was performed on 104 patients with disabling discogenic low back pain treated with single-level lumbar ProDisc total disc arthroplasty. Smokers and nonsmokers were assessed before surgery and after surgery using patient satisfaction, Oswestry, and Visual Analog Scores. Additionally, preoperative and postoperative neurologic, radiographic, and pain medication assessments were performed at similar postoperative intervals. RESULTS: Oswestry, Visual Analog Scores, and patient satisfaction scores revealed statistical improvement beginning 3 months after surgery and were maintained at minimum 2-year follow-up. Patient satisfaction scores were higher in smokers (94%) than in nonsmokers (87%) at 2-year follow-up (P = 0.07). Radiographic analysis revealed an affected disc height increase from 4 mm to 13 mm (P < 0.05) and an affected disc motion from 3 degrees to 7 degrees (P < 0.05). No cases of loosening, dislodgment, mechanical failure, infection, or fusion of the affected segment occurred. CONCLUSIONS: The results of our study indicate that smokers do equally well compared with nonsmokers when ProDisc ADR is used in the treatment of debilitating lumbar spondylosis. Patient outcome and radiographic scores showed significant improvement compared with preoperative levels. Although not evident in our series, additional surveillance for intraoperative and postoperative vascular spasm and occlusion may be warranted in smokers.
Assuntos
Artroplastia de Substituição/instrumentação , Disco Intervertebral/cirurgia , Prótese Articular , Vértebras Lombares/cirurgia , Fumar/efeitos adversos , Adolescente , Adulto , Artroplastia de Substituição/métodos , Seguimentos , Humanos , Disco Intervertebral/fisiopatologia , Instabilidade Articular , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Dor , Satisfação do Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
On the basis of the anatomy of the disc, the nucleus as pain generator and the resulting treatment possibility using nucleus replacement technologies are reviewed. Various devices are presented, from the first historical steps to treatment possibilities in the future. Clinical experiences of the widely-used PDN prosthetic device are analyzed.
Assuntos
Artroplastia de Substituição/instrumentação , Disco Intervertebral/cirurgia , Prótese Articular , Vértebras Lombares/cirurgia , Osteofitose Vertebral/cirurgia , Artroplastia de Substituição/métodos , Feminino , Seguimentos , Humanos , Disco Intervertebral/patologia , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Teste de Materiais , Medição da Dor , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Osteofitose Vertebral/diagnóstico por imagem , Resultado do TratamentoRESUMO
This article focuses on the clinical results of three prostheses (the Bryan Cervical Disc, the Bristol Disc, and the ProDisc-C) for cervical total disc replacement. Background on the development, design, and biomechanical characteristics of each prosthesis is given and surgical indications and clinical results are summarized and analyzed.
Assuntos
Artroplastia de Substituição/métodos , Vértebras Cervicais/cirurgia , Prótese Articular , Desenho de Prótese , Osteofitose Vertebral/cirurgia , Adulto , Idoso , Artroplastia de Substituição/instrumentação , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Disco Intervertebral/cirurgia , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Medição de Risco , Osteofitose Vertebral/diagnóstico por imagem , Resultado do TratamentoRESUMO
Hybrid constructs can combine motion-preserving technologies with each other or motion-preserving technologies with fusion techniques. Hybrid constructs can be implanted in single-stage or multistage surgeries. Early results are promising. Further study under formal scientific conditions is necessary to explore the benefit of these combinations.
Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Dispositivos de Fixação Ortopédica , Fusão Vertebral/instrumentação , Adulto , Fenômenos Biomecânicos , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
Spinal arthroplasty is an acceptable alternative to fusion in many cases of disabling degenerative disc disease. Although arthroplasty has been demonstrated to be a safe and efficacious surgical option, complications related to the approach or the device may occur in few cases. Revision strategies for failed total disc arthroplasty can be planned as a posterior fusion, leaving the total disc replacement device in place, or by way of anterior removal with subsequent anterior fusion or revision replacement of the prosthesis.
