Clinical results of total lumbar disc replacement with ProDisc II: three-year results for different indications.
ABSTRACT Prospective study analyzing midterm clinical results of total lumbar disc replacement (ProDisc II) for different indications.
To assess functional outcome after total lumbar disc replacement (TDR) treated for varying indications.
Despite its frequent use and increasing popularity, indications and contraindications for TDR have not been defined precisely at this stage and remain a matter of debate, leading to disc replacement procedures in a variety of pathologies that have not yet been evaluated and compared separately.
Patients meeting inclusion criteria were evaluated prospectively according to Visual Analogue Scale (VAS), Oswestry Questionnaire, SF-36, and numerous clinical parameters. Indications included degenerative disc disease (DDD), DDD with accompanying soft disc herniation (nucleus pulposus prolapse, NPP), osteochondrosis following previous discectomy, and DDD with presence of Modic changes. Postoperative improvement was recorded and analyzed for influence of preoperative diagnosis.
Overall, 92 patients from four groups with a mean follow-up of 34.2 months (minimum, 24 months) achieved significant and maintained improvement from preoperative levels (P < 0001). Patients with DDD + NPP achieved results significantly better than patients from the other groups (P < 0.05). Presence of Modic changes or previous discectomy did not influence outcome negatively. Improvement was achieved for both monosegmental and bisegmental disc replacements (P < 0.05), nevertheless with significantly inferior results for bisegmental interventions at 12- and 24-month follow-up and considerably higher complication rate. While older patients were still highly satisfied with postoperative outcome, better functional outcome was observed in younger patients.
Present data suggest beneficial clinical results of TDR for treatment of DDD in a highly selected group of patients. Better functional outcome was obtained in younger patients under 40 years of age and patients with degenerative disc disease in association with disc herniation. Multilevel disc replacement had significantly higher complication rate and inferior outcome. Results are significantly dependent on preoperative diagnosis and patient selection, number of replaced segments, and age of the patient at the time of operation. Because of significantly varying outcomes, indications for disc replacement must be defined precisely.
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ABSTRACT: Objective: To compare outcomes after imaging-guided transforaminal lumbar nerve root blocks in MRI confirmed symptomatic disc herniation patients with and without Modic changes (MC). Methods: Consecutive adult patients with MRI confirmed symptomatic lumbar disc herniations and an imaging-guided lumbar nerve root block injection who returned an outcomes questionnaire are included. Numerical rating scale (NRS) pain data was collected prior to injection and 20-30 min after injection. NRS and overall improvement were assessed using the patient's global impression of change (PGIC) scale at 1 day, 1 week and 1 month post injection. The proportion of patients with and without MC on MRI as well as Modic I and Modic II was calculated. These groups were compared for clinically relevant 'improvement' using the Chi-squared test. Baseline and follow-up NRS scores were compared for the groups using the unpaired t-test. Results: 346 patients are included with MC present in 57%. A higher percentage of patients without MC reported 'improvement' and a higher percentage of patients with MC reported 'worsening' but this did not reach statistical significance. The numerical scores on the PGIC and NRS scales showed that patients with MC had significantly higher pain and worse overall improvement scores at 1 month (p = 0.048 and p = 0.03) and a significantly lower 1 month NRS change score (p = 0.04). Conclusions: Patients with MRI confirmed symptomatic lumbar disc herniations and MC report significantly lower levels of pain reduction after a lumbar nerve root block compared to patients without MC.European Journal of Radiology 06/2014; 83(10). DOI:10.1016/j.ejrad.2014.06.008 · 2.16 Impact Factor
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ABSTRACT: The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR.03/2015; 9:7. DOI:10.14444/2007
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ABSTRACT: Background The aim of this research is to analyze the influence of Modic types on the clinical results of cervical spondylotic myelopathy treated by anterior cervical diskectomy and fusion.MethodsA total of 106 patients with a mean age of 55.8¿±¿6.5 years were included in this study. Patients with Modic changes were retrospectively reviewed. In this study, 23 patients were classified as Modic-1, 39 patients were classified as Modic-2, and 44 patients were classified as Modic-0. Clinical evaluations were performed preoperatively and repeated at 3, 6, 12, and 24 months after operation.ResultsIn this study, all patients were followed up for a mean period of 30.2 months (range, from 24 to 36 months). Significant clinical improvement (P¿<¿0.05) was observed in Japanese Orthopaedic Association (JOA) score and axial symptoms between the preoperative evaluation and the final follow-up. Comparing the result of mean JOA score after anterior cervical diskectomy and fusion (ACDF) in the Modic-1 group and other groups, statistically significant differences could be found at 12 months after surgery (P¿<¿0.05). Comparing the outcome visual analog scale (VAS) of axial symptoms among different groups after ACDF, patients with Modic-1 changes showed significantly lower VAS of axial symptoms postoperatively (P¿<¿0.05).Conclusion After anterior cervical diskectomy and fusion, both Modic-1 and Modic-2 groups showed excellent clinical outcomes over a 2-year follow-up. Better clinical results were achieved in patients with Modic-1 changes compared to the group of patients with Modic-2 and Modic-0 changes on magnetic resonance images.Journal of Orthopaedic Surgery and Research 01/2015; 10(1):11. DOI:10.1186/s13018-014-0146-8 · 1.58 Impact Factor