237 - Spinal Disc Replacement in a Community Practice Setting: Early Results...

#237 Spinal Disc Replacement in a Community Practice Setting: Early Results

Lumbar TDR

Poster Presented by: G.R. Buttermann


G.R. Buttermann (1)

(1) Midwest Spine Institute, Stillwater, MN, United States


Introduction: Lumbar total disc replacement, TDR, has now become an option in some U.S. communities as an alternative to lumbar fusion for advanced DDD. U.S. FDA/IDE trials comparing lumbar total disc replacement versus spinal fusion for a one level condition are now out to five year follow-up. However, comparative studies for a lumbar total disc replacement in a community setting outside of an IDE setting are few. The purpose of the present study is to compare a lumbar total disc replacement for one level conditions as well as off label combination of disc replacement and spinal fusion as a “hybrid” construct for multilevel conditions in a community spine practice.

Methods: Patients were followed preoperatively and up to 2-4 years postoperatively with radiographs (always including flexion/extension views) as well as multiple self-assessment patient-based outcomes surveys (Pain VAS, ODI, pain drawing, pain medication use, perception of success). Four cohorts were analyzed: single level lumbar total disc replacement (N=26), single level anterior/posterior spinal fusion (N=62), TDR hybrid (N=21) and two level anterior/posterior lumbar fusion (N=50).

Results: Both TDR and spinal fusion groups had significantly improved outcomes after surgery at all follow-up periods for both single level and multilevel cases. There was no significant difference in outcomes between single level and multilevel cases within both the fusion and TDR groups. For single level cases, the TDR group had significantly greater ODI improvement relative to the fusion group at all follow-up periods and a trend for greater VAS improvement at 1-2yr and 2-4 yr follow-up periods. For multi-level cases, the improvement was similar for the hybrid and fusion group at all follow-up periods. Implant costs were less for single level total disc replacement compared to spinal fusion but equivalent or greater for hybrid constructs compared to multilevel fusion constructs. Range of motion was maintained in the total disc replacement groups. Secondary surgeries were greater for the fusion groups (instrumentation removal and adjacent segment conditions).

Conclusion: Similar to institutional IDE single level TDR studies, our results have shown maintained range of motion, a trend toward better outcomes during the early follow-up period and less secondary surgeries.

Fusion Oswestry Disability Index

TDR Oswestry Disability Index