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Related Experiment Video

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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
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Physical capability outcomes after total disc replacement with ProDisc-L.

Humbert G Sullivan1, Robert L Bobenmoyer2, Kevin M Boland3

  • 1Department of Neurosurgery, Gundersen Lutheran Health System, La Crosse, WI.

International Journal of Spine Surgery
|February 20, 2015
PubMed
Summary

Total disc replacement (TDR) with ProDisc-L significantly improves physical function and reduces pain. Objective physical performance metrics are feasible for assessing TDR outcomes, showing substantial patient gains.

Keywords:
Disc arthroplastyOutcome assessmentProDisc-LTotal disc replacement

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Area of Science:

  • Spine surgery outcomes research
  • Biomechanical engineering
  • Rehabilitation medicine

Background:

  • Traditional lumbar disc arthroplasty (total disc replacement [TDR]) outcome assessments rely on subjective patient-reported measures.
  • Objective physical performance data collection was mandated by our institution's health plan for TDR coverage.
  • This study aimed to evaluate the feasibility and impact of objective functional capacity tasks as outcome metrics for TDR.

Purpose of the Study:

  • To assess the feasibility of using preoperative and 1-year postoperative functional capacity tasks (PCAT) as an outcome metric for ProDisc-L (PD-L) TDR.
  • To quantify the magnitude and statistical significance of changes in physical performance after PD-L implantation.
  • To determine if observed changes in physical performance correlate with improvements in subjective patient-reported outcomes.

Main Methods:

  • Eighteen patients undergoing single or two-level PD-L implantation were assessed.
  • Seven adapted WorkWell tasks (physical capability assessment tool [PCAT]) were administered preoperatively and at 1-year postoperatively.
  • Demographic, medical, and subjective outcome data (pain, Oswestry Disability Index, narcotic use) were collected and analyzed.

Main Results:

  • The PCAT was feasible, taking approximately 30 minutes to complete.
  • Significant improvements were observed across all PCAT tasks, with gains ranging from 32% (push) to 128% (floor-to-waist lift) (P < .001 for most tasks).
  • Patient-reported outcomes also showed significant improvements: Visual Analog Scale for pain (P < .001), Oswestry Disability Index (P < .001), and reduced narcotic use (P = .031).

Conclusions:

  • Objective physical capability assessment using the PCAT is a feasible outcome metric for TDR.
  • ProDisc-L implantation leads to substantial improvements in objective physical performance.
  • Further research with larger cohorts and longer follow-up is warranted to confirm these findings and their implications for long-term patient health and healthcare costs.