General Session: Cervical Motion Preservation

Presented by: R. Guyer - View Audio/Video Presentation (Members Only)


R. Guyer(1), J. Zigler(1), D. Ohnmeiss(2)

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


Introduction: There are multiple studies describing the results of single-level lumbar total disc replacement (TDR), but less information in available for 2-level procedures. The purpose of this study was to investigate the clinical outcomes of lumbar TDR at 2-levels.

Methods: Records for a spine specialty center were reviewed to identify patients who underwent lumbar TDR and had minimum 24 month follow-up data available. There were 141 patients with a mean follow-up of 54.1 months. Implants used were either the ProDisc-L or Charite. Data collected included the Oswestry Disability Index (ODI), visual analog scales (VAS) assessing back pain and leg pain, and re-operations. All cases were performed for painful disc degeneration at two adjacent levels that was unresponsive to non-operative care.

Results: Mean operative blood loss was 96.5 ml. The mean ODI scores improved significantly from 53.0 to 27.7 (p< 0.05). Back and leg pain scores also improved significantly (Figure 1; p< 0.05). Eighteen (12.8%) patients underwent re-operation. Three (2.1%) patients underwent fusion at the TDR levels, 5 (3.5%) were at an adjacent segment, one was for incision and debridement for a superficial wound infection, and 9patients underwent spinal cord stimulator implantation for pain control.

Discussion: The results of this study found that lumbar TDR at two levels produced good results, similar to those reported in the literature for single-level cases. These findings support that 2-level TDR is a viable alternative in the treatment of painful disc degeneration unresponsive to non-operative care in appropriately selected patients.

Figure 1. Significant improvement in VAS scores.