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Analysis of adjacent segment reoperation after lumbar total disc replacement
Scott Rainey1, Scott L Blumenthal2, Jack E Zigler2
1Texas Back Institute Research Foundation, Plano, TX.
International Journal of Spine Surgery
|February 20, 2015
Summary
Total disc replacement (TDR) showed a 2.0% reoperation rate for adjacent segment degeneration, which is lower than rates seen with lumbar fusion. Preoperative assessment of adjacent segments may further reduce this risk.
Area of Science:
- Spine surgery
- Orthopedic research
- Biomedical engineering
Background:
- Spinal fusion is a common treatment for chronic back pain.
- Adjacent segment degeneration (ASD) is a complication of fusion, potentially requiring reoperation.
- Total disc replacement (TDR) is an alternative aiming to reduce ASD.
Purpose of the Study:
- To determine the reoperation rate for ASD after lumbar TDR.
- To analyze the preoperative condition of adjacent segments in TDR patients.
Main Methods:
- Retrospective review of 1000 TDR patients and 67 fusion patients.
- Analysis of pre- and post-operative radiographs, MRI, and CT scans.
- Comparison of ASD reoperation rates between TDR and fusion groups.
Main Results:
- 2.0% of TDR patients (20/1000) required reoperation for ASD.
- The mean time to reoperation was 28.3 months.
- Preoperative adjacent segment degeneration was present in 61.2% of TDR patients.
Conclusions:
- The ASD reoperation rate after TDR (2.0%) is comparable to other studies and lower than after lumbar fusion (4.5% in this study).
- Careful preoperative assessment of adjacent segments may further decrease ASD rates.
- TDR may offer an advantage in reducing ASD compared to fusion.
