Facet Arthropathy Following Disc Replacement Versus Rehabilitation: A Prospective Study With 8-Year Follow-Up

Area of Science:

• Spine surgery outcomes
• Degenerative spine disease research
• Biomechanical effects of spinal implants

Background:

• Facet arthropathy (FA) is a potential complication following total disc replacement (TDR).
• The natural progression of FA after TDR and its long-term clinical impact remain unclear.
• Previous studies have not comprehensively compared FA development after TDR versus nonoperative treatment.

Purpose of the Study:

• To evaluate the long-term incidence and progression of facet arthropathy (FA) after TDR.
• To compare FA development in patients undergoing TDR versus nonoperative treatment.
• To analyze the association between FA and clinical outcomes, including pain and disability.

Main Methods:

• Prospective study of 126 patients with chronic low back pain and degenerative disc disease.
• Comparison between TDR and multidisciplinary rehabilitation groups.
• 8-year follow-up with magnetic resonance imaging (MRI) and computed tomography (CT) to assess FA using Weishaupt grading.
• Clinical outcomes measured by Oswestry Disability Index (ODI) and back pain levels.

Main Results:

• Increased facet arthropathy (FA) at the index level was significantly more common after TDR (36%) compared to nonoperative treatment (2%) (P < 0.001).
• Higher FA grades at follow-up were observed after TDR (OR 4.0 MRI, 5.9 CT), but this was not associated with improved Oswestry Disability Index (ODI) scores.
• Four TDR patients (6%) required reoperation for lateral recess stenosis at the index level, while no nonoperative patients did.

Conclusions:

• Facet arthropathy (FA) development is more probable after total disc replacement (TDR) than nonoperative treatment.
• The presence of FA at the index level did not correlate with the 8-year clinical outcome (ODI or back pain).
• Facet arthropathy (FA) may be a contributing factor to reoperations in patients who have undergone TDR.