Lumbar Total Disc Replacement
ABSTRACT The patient was a 27-year-old woman with an 18-month history of low back pain that was insidious in onset. She worked as a military pilot, and her pain was unresponsive to all nonsurgical measures. Magnetic resonance imaging revealed a L4-5 herniated nucleus pulposus, and 6 months later the patient underwent an L4-5 microdiscectomy. However, due to continued debilitating pain, she was medically removed from flight status and was pending discharge from the military. The patient underwent an L4-5 total disc replacement using the Maverick disc prosthesis. The patient began treatment with a physical therapist 1 month after total disc replacement surgery. At 6 months, 1 year, and 2 years following total disc replacement, Oswestry Disability Index scores were 0%. Additionally, the patient returned to flight status and full recreational activities. J Orthop Sports Phys Ther 2011;41(3):200. doi:10.2519/jospt.2011.0405.
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ABSTRACT: Few studies are available for the long-term outcome of disc arthroplasty using the Prodisc prostheses. We evaluated if total disc arthroplasty using the Prodisc prosthesis could be a reliable treatment for disabling low-back pain,and if long lasting improvement in quality-of-life could be achieved. We hypothesized that analysis of a prospective cohort study with a mean 5-year follow-up, clinical control, done by heumatologists not involved in treatment would provide data that was not influenced by surgeon bias. Thirty-nine patients undergoing disc replacement between May 2002 and July 2004 were the study population. Fifty-two levels from L2 to S1, of which 28 were single-level, 9 were double-level and two were three levels, were treated. Independent clinical evaluation by uninvolved rheumatologists was done preoperatively at 1, 2 and 5 years after surgery. The Visual Analogue Score (VAS) for leg and lumbar pain intensity, Oswestry Low Back Pain Disability Index (ODI), Short Form-36 (SF-36), patient satisfaction, and the return to work rate were assessed. Analysis revealed a significant amelioration of the VAS for back and leg pain, as well as for the ODI and the SF-36. Since this is a motion preservation device study it is important to include range of motion ROM analysis at the follow-up times. These data suggest that total disc arthroplasty using the prodisc prosthesis is a good treatment option for disabling discogenic low back pain. The improvement achieved after 1 year could be conserved at 2- and 5-year follow up.The Open Spine Journal 11/2011;