General Session: Cervical Motion Preservation

Presented by: F. Marcelino - View Audio/Video Presentation (Members Only)

Author(s):

L. Marchi(1), R. Amaral(1), E. Coutinho(1), J. Nogueira-Neto(1), L. Oliveira(1), R. Jensen(1), N. Faulhaber(1), F. Marcelino(1), L. Pimenta(1,2)

(1) Instituto de Patologia da Coluna, Sao Paulo, Brazil
(2) UCSD, Neurosurgery, San Diego, CA, United States

Abstract

Introduction: The purpose of this study was to analyze radiological and clinical results with a minimum 5-year follow-up (FUP) of lateral lumbar total disc replacement (TDR) for the treatment of symptomatic degenerative disc disease.

Methods: Prospective non-randomized single-center study. Cases treated with lumbar total disc replacement (XL-TDR prosthesis) done by a lateral transpsoas approach. From 2005 to 2012, 60 cases were enrolled (31 male, 29 female; total 66 levels; average age 42.8 y/o SD 9.7, 22-64 range; mean BMI 26.0 SD 3.4). Endpoints included VAS and ODI questionnaires, radiographic outcomes such as heterotopic ossification and maintenance of disc motion, complications and reoperation. Heterotopic ossification grades according to McAfee classification.

Results: The mean surgical duration was 122 minutes (SD 45) with mean 58mL (SD 21) of EBL. No intraoperative complication occurred. All but three patients stood up/ walked at the same day. The exceptions were one case within apnea post anesthesia and two case with quadriceps motor deficit (resolved within 4 months with physiotherapy). Eleven of the 60 patients (18%) were lost to FUP or had not completed at least a 5-year FUP, and 49 were enrolled (53 levels) in the analysis. Mean FUP of 93 months (range, 60-122). In total, five levels (10%; 5/53) required to be fused. Both removal of the prostheses and interbody fusion were performed by the lateral transpsoas approach. One case due CrCo allergy (at 2 months); four due persistent pain from different causes (at 7, 9, 24 and 88 months). Two cases (4%; 2/9) evolved with adjacent level disease that required surgery (at 24 and 96 months). One case required sacro-iliac fusion at 63 months. No complication occurred in the retrieval surgeries. It was identified one partial disc migration at 60 months with no need for retrieval. Flex/ext films from 38 levels were available at least at a 5-year FUP. Heterotopic ossification grade 0= 13%; grade I= 18%; grade II= 32%; grade III= 16%; grade IV (no motion)= 21% (8 cases). Most heterotopic ossification cases (85%) occurred in the lateral aspect of the disc space. Patient-reported outcomes showed significant improvement (p< 0.01) maintained up to minimum 5 years. VAS back pain: preop 8.5, postop early 2.5, and last FUP 3.0. ODI: preop 54%, postop early 31%, and last FUP 21%.

Conclusions: This study presents mid to long-term FUP results of the use of XL-TDR artificial disc for the treatment of lumbar degenerative disc degeneration. The benefits of this option include minimal fast mobilization and lower rate of adjacent level disease. The data show satisfactory sustained pain relief and improved physical function for patient with the disc. Some cases needed to be surgically reversed to fusion with no additional complications and some had natural ankyloses. Lumbar artificial disc replacement done by the lateral approach seems an effective treatment for feasible for mild DDD.

Heterotopic ossification around the TDR