393 - Does Lumbar Total Disc Replacement Reduce the Risk of Development of S...

#393 Does Lumbar Total Disc Replacement Reduce the Risk of Development of Sacro-Iliac Joint Pain? Results at 10 Years

Lumbar TDR

Poster Presented by: P. Otten

Author(s):

P. Otten (1)
R. Ciarpaglini (2)
G. Maestretti (2)

(1) Clinique Générale de Fribourg, Fribourg, Switzerland
(2) Hopital de Fribourg, Fribourg, Switzerland

Abstract

Sacro-iliac joint pain (SIJ) has been described as high as 20 to 25% of patient undergoing a lumbar fusion.

In order to examine the incidence of SIJ in lumbar total disc replacement we have specifically examined this syndrome in a group of patient who has been prospectively followed since 2002, at the ten years follow-up. The initial group consist of 39 patients. AT ten years we could clinically and radiologically evaluate 31 patients. Clinical outcome is favorable with a mean lumbar VAS of 3.4 and ODI of 31 %. Level of activity has decreased over years, 42% still practicing sport, and 13 patient still working but only 3 full-time. 15 patient has their prosthesis either fused of hypomobile.

4 patients had clinical signs of SIJ pain, all with positive infiltration testing. Two of those patients had SIJ fusion (I-Fuse, SI-Bone). Those patient present for two of them with spontaneous fusion of their disc, two with reduced mobility of their prosthesis over years, all of them at the L5-S1 level. One of those patient also had fusion at L3-4 and L4-5 level.

In summary we present a series of lumbar total disc replacement with ten years follow-up.12% of our patient present with SIJ pain at ten years follow-up after lumbar TDR. This level may lower than expected compared to lumbar fusion, but the patients with SIJ pain belong to the sub-group of patients with fused or hypomobile L5-S1 prosthesis. This underline the biomecanical importance of the last mobile segment for the biomechanics of the pelvis.

This preliminary analysis should be confirmed by larger and randomized studies.