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The indications for lumbar and cervical disc replacement.
1Scoliosis and Spine Center, St. Joseph Hospital, O'Dea Medical Building 104, 7505 Osler Drive, Towson, MD 21204, USA. mack8132@aol.com
The Spine Journal : Official Journal of the North American Spine Society
|November 16, 2004
Summary
Cervical disc replacement is more versatile than lumbar disc arthroplasty due to surgical approach differences and indications. Cervical procedures accommodate neurologic deficits, while lumbar ones exclude radiculopathy in current studies.
Area of Science:
- Spinal Surgery
- Orthopedics
- Neurosurgery
Background:
- Cervical and lumbar disc replacements are emerging spinal surgical techniques.
- Established indications differentiate current clinical applications for each procedure.
Purpose of the Study:
- To delineate the distinct indications for cervical versus lumbar disc replacement.
- To compare the surgical applicability and limitations of each procedure.
Main Methods:
- Comparative analysis of current clinical indications and surgical approaches.
- Review of Food and Drug Administration (FDA) Investigational Device Exemption (IDE) study criteria.
Main Results:
- Lumbar disc arthroplasty is indicated for discogenic back pain without radiculopathy.
- Cervical disc replacement is suitable for patients with neurologic deficits, radiculopathy, or myelopathy.
- Cervical procedures allow for more complex surgeries like osteotomies and deformity correction.
- Radiculopathy is an exclusion criterion for lumbar IDE studies but an inclusion criterion for cervical IDE studies.
Conclusions:
- Cervical disc replacement offers broader applicability, especially in cases with neurologic involvement.
- Surgical approach and revision complexity favor cervical disc replacement over lumbar procedures.
- Surgeons exhibit greater trepidation towards multilevel lumbar arthroplasties, particularly with neurologic symptoms.
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