214 - Pregnancy after Lumbar Total Disc Replacement...

#214 Pregnancy after Lumbar Total Disc Replacement

Lumbar TDR

Poster Presented by: J.E. Zigler

Author(s):

A. Owusu (1)
J.E. Zigler (2)
D.D. Ohnmeiss (1)
R.D. Guyer (2)

(1) Texas Back Institute Research Foundation, Plano, TX, United States
(2) Texas Back Institute, Plano, TX, United States

Abstract

Introduction: Lumbar total disc replacement (TDR) has been found to be a viable treatment for painful disc degeneration unresponsive to non-operative care. The age of patients indicated for this procedure begins with 18 years and in most clinical TDR studies the mean age ranges from 40 to 45 years. This suggests that there are females of child baring age who may receive, or be interested in receiving, lumbar TDR. There is much literature investigating back pain during pregnancy, but a paucity of information exists for patients contemplating surgery who may wish to become pregnant later. Currently available TDRs are designed for implantation using an anterior approach to the lumbar spine which may increase patient concerns about pregnancy after surgery. The purpose of this study was to evaluate the course of back pain and safety of pregnancy after lumbar TDR.

Methods: From a single center, 10 patients were identified who became pregnant after lumbar TDR surgery. Data were recorded from study records to determine if the patients experienced increased pain or had any complications with their pregnancy or delivery. The mean age of the patients was 29.9 years, ranging from 25 to 38 years.

Results: All of the TDR procedures were performed at a single level, with nine at L5-S1 level and one at L4-5. Half of the patients had delivery via Cesarean section and the others underwent vaginal delivery. There were no pregnancy-related complications. One patient reported moderately increased back pain during pregnancy which resolved after delivery.

Discussion: Although based on a small patient sample, this study found that pregnancy after lumbar TDR surgery followed a typical course with no spine related complications. One patient reported back pain of moderate severity during pregnancy which resolved post-delivery. Although planning to become pregnant was an exclusion criterion for the FDA IDE trial for TDRs, this was mainly due to striving for homogeneity of the study group and the need to not obtain routine follow-up radiographs on pregnant patients. It is hoped that this study may provide reassurance to women who become pregnant after TDR surgery that there should not be undue concern about the safety of pregnancy and delivery.