The mid- and long-term follow-up of total disc replacement for lumbar intervertebral disc degenerative diseases

English Keywords:Lumbar intervertebral disc degenerative diseases  Artificial intervertebral disc replacement  Clinical outcomes

English Abstract:

  【Abstract】 Objectives: To determine the mid- and long-term clinical results of lumbar total disc replacement(TDR) in patients with degenerative disc diseases. Methods: From December 1999 to December 2006, 78 patients with lumbar intervertebral disc degenerative diseases were treated with TDR. Among these patients, 48 patients(52 prosthesis) had follow-ups of no less than 5 years. Clinical and radiographic results of these patients were evaluated before surgery and at final follow-up. The clinical outcomes were evaluated by Visual Analogue Scale(VAS) and Oswestry disability index(ODI). Radiographic parameters including range of motion(ROM) and intervertebral disc height(IDH) of the index level were evaluated by A-P and dynamic X-ray. Results: 33 patients had 5 to 10 years′（including 5 years′, not including 10 years′） follow-up(group A), and 15 patients had more than 10 years′(including 10 years′) follow-up(group B). VAS score: group A had 94.0±6.3 preoperatively and 23.0±3.1 at final follow-up; group B had 92.0±5.8 preoperatively and 21.0±2.2 at final follow-up, which showed significant difference between preoperative score and final follow-up score in each group(P＜0.05). ODI: ODI of group A was (66.0±4.2)% preoperatively and (12.0±2.9)% at final follow-up; It was (65.0±7.8)% group B preoperatively and (9.0±2.8)% at final follow-up. The difference of ODI between preoperation and final follow-up in each group was significant(P＜0.05). ROM: group A had a ROM of 5.0°±2.3° preoperatively and 6.0°±1.1° at final follow-up; group B had a ROM of 4.0°±3.8° preoperatively and 6.0°±2.2° at final follow-up. There was no significant difference between preoperative ROM and the final follow-up ROM（P＞0.05）. 3 cases lost ROM at the index level(average 1.2°±0.4°, one occurred at 5 years after TDR and the other two at 7 years after TDR), while others remained an average ROM of 6.5°(range, 2°-10°). 4 cases developed adjacent-level degeneration, but only one was symptomatic at upper disc and needed reoperation(8 years after TDR). One of the 4 cases lost disc height over 2mm at final follow-up(7 years after TDR), and the other 2 cases had ossification in the anterior part of the upper vertebral body over 3mm(one at 5 years, the other at 8 years). 2 prosthesis were found to be displaced(one at 5 years, the other at 6.5 years) and 3 cases developed heterotopic ossification(respectively at 6, 7 and 9 years), but none of them had symptoms. Conclusions: The mid- and long-term outcome of lumbar TDR for intervertebral disc degenerative diseases with SB Charite Ⅲ prosthesis is of satisfactory.