281 - Viscoelastic Lumbar Total Disc Replacement in the Treatment of Spondyl...

#281 Viscoelastic Lumbar Total Disc Replacement in the Treatment of Spondylolisthesis and Degenerative Scoliosis

Lumbar Therapies and Outcomes

Poster Presented by: B. Rischke

Author(s):

B. Rischke (1)

(1) Spine-Center-Rischke, Center of Orthopaedic and Spine Surgery, Zurich, Switzerland

Abstract

Purpose: To evaluate potential expanded indications for lumbar total disc replacement (TDR) with a viscoelastic total disc replacement (VTDR).

Introduction: Degenerative disc disease is the current indication for lumbar TDR. Contraindications for TDR include significant scoliosis, spondylosis, spondylolisthesis, stenosis and other segment structural abnormalities. It is proposed that a next generation prostheses with a constrained design featuring higher stiffness in flexion, extension and rotation may have the potential to provide adequate stability in patients with these contraindications, either alone or in combination with fusion or motion preserving implants. The involved VTDR is a one-piece viscoelastic device that provides physiologic stiffness and restraint to excess motion.

Methods: Two case studies are described as an evaluation of expanded indications for the VTDR. The first patient (patient 1) is male with preoperative grade III spondylolisthesis at L5/S1. The patient was treated with a ventral intervention and decompression with implantation of the VTDR, followed by dorsal approach and implantation of a posterior dynamic stabilization system. The second patient (patient 2) presented with degenerative scoliosis of 26 degrees preoperative and was treated with the VTDR at L2/L3 and L4/L5 and an anterior cage at L3/L4.

Results: Patient 1 presented with VAS low back and leg pain scores of 90mm and 80mm, respectively. Both scores were reduced to 0mm at three years follow up. The patient's EQ-5D health status index improved from 0.055 preoperatively to 1.0 at three years post-op. Patient 2 had preoperative NASS back and leg pain scores of 50mm and 80mm, respectively, which were improved to 0mm at one year postoperative. The EQ-5D score for patient 2 also improved from 0.055 preoperatively to 1.0 at one year follow up.

Conclusions: Two patients with typical contraindications to TDR demonstrated good clinical outcomes after treatment with a VTDR in combination with another implant system. The early positive results experienced by these patients suggest that the VTDR may be appropriate, alone or in combination with other motion sparing or fusion devices, for treating some patients with typical contraindications to TDR. Further research is warranted.

Caution-Investigational device. Limited by Federal (or U.S.) law to investigational use.

Figure 1: Spondylolisthesis at L5/S1

Figure 2: Degenerative Scoliosis