0
Surgical Techniques   |    
Lumbar Total Disc Replacement
Patrick Tropiano, MD1; Russel C. Huang, MD2; Federico P. Girardi, MD3; Frank P. CammisaJr., MD3; Thierry Marnay, MD4
1 Department of Orthopaedic Surgery, Hôpital CHU Nord, Chemin des Bourrelly, 13915 Marseille CEDEX 20, France. E-mail address: ptropiano@ap-hm.fr
2 The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for R.C. Huang: russelhuang@yahoo.com
3 The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
4 Department of Orthopaedic Surgery, Clinique du Parc, 50 Rue Emile-Combes, Boite Postal 20, 34171 Castelnau-le-Lez, France
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 490-496, March 2005
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Synthes Company. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Synthes Company). Also, a commercial entity (Purdey education program) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which one or more of the authors are affiliated or associated.
The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart@haderermuller.com).
Investigation performed at the Department of Orthopaedic Surgery, Clinique du Parc, Castelnau-le-Lez, France

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(1 suppl 1):50-64. doi: 10.2106/JBJS.E.01066
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

BACKGROUND: Symptomatic lumbar degenerative disc disease is a challenging entity to treat. The results of arthrodesis may be compromised in the short term by pseudarthrosis and in the long term by pain at the iliac-crest donor site and by junctional degeneration. Total disc replacement has the potential to provide long-lasting relief to these patients. The purpose of this study was to present the clinical and radiographic results assessed seven to eleven years following a Prodisc total lumbar disc replacement.

METHODS: Sixty-four patients had single or multiple-level implantation of a total lumbar disc replacement between 1990 and 1993. The mean duration of follow-up was 8.7 years. Clinical results were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and post-operative radiographs were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and post-operative radiographs were evaluated as well. Subgroup analysis was performed to determine if gender, an age of less than forty-five years, previous surgery, or multilevel surgery had an effect on outcome.

RESULTS: At an average of 8.7 years post-operatively, there were significant improvements in the backpain, radiculopathy, disability, and modified Stauffer-Coventry scores. Thirty-three of the fifty-five patients with sufficient follow-up had an excellent result, eight had a good result, and fourteen had a poor result. Neither gender nor multilevel surgery affected outcome. An age of less than forty-five years and prior lumbar surgery had small but significant negative effects on outcome. Radiographs did not demonstrate loosening, migration, or mechanical failure in any patient. Five patients had approach-related complications.

CONCLUSIONS: The Prodisc lumbar total disc replacement appears to be effective and safe for the treatment of symptomatic degenerative disc disease. Gender and multilevel surgery did not affect the outcomes, whereas prior lumbar surgery or an age of less than forty-five years was associated with slightly worse outcomes. Longer follow-up of this cohort of patients and randomized trials comparing disc replacement with arthrodesis are needed.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    05/03/2012
    California - UCLA/OH Department of Orthopaedic Surgery
    03/05/2014
    Oklahoma - The University of Oklahoma
    01/22/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina