An Evidence-Based Medicine Approach in Determining Factors That May Affect Outcome in Lumbar Total Disc Replacement

Abstract

Existing evidence does not provide definite conclusions in the majority of the questions regarding indications and factors that may affect outcomes. Where feasible, conclusions are mainly drawn from lower level, least reliable evidence. Highest quality data are short-term whereas longer-term data are of lower quality and in many instances conflicting. More high level studies with long-term follow-up are necessary to shed light to important clinical issues.

Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up

“…Merging no arthrosis with slight arthrosis (grade 0 and 1) and moderate with severe arthrosis (grade 2 and 3) e Aprill and Bogduk [22] f Luoma et al [23] Eur Spine J (2012) 21:681-690 685 predictors found in previous studies [7,27,28]. Zindrick et al [10] concluded in a review that there was no definitive evidence about which variables that affect outcome in disc prosthesis surgery. Siepe et al [28,29], reported better outcomes for disc surgery in younger patients, for monosegmental surgery (especially at the L4/L5 level) and in patients with lower disc height.…”

“…There is limited knowledge about valid predictors of good or poor outcomes in patients treated with multidisciplinary rehabilitation, fusion and especially disc prosthesis [10]. Improving the ability to predict treatment outcome may allow for better allocation of resources.…”

Two-level total lumbar disc replacement

“…Total lumbar disc replacement is a controversial alternative to lumbar fusion in the treatment of degenerative disc disease [31]. Results from prospective randomised trials have shown non-inferiority of arthroplasty with SB Charitè prosthesis over fusion with BAK-cages for monosegmental disc disease at L4-L5 and L5-S1 [4].…”

In silico evaluation of a new composite disc substitute with a L3–L5 lumbar spine finite element model

“…Also because prosthesis shapes are standardized geometrical patient-specificity is limited and strong correlations exist between prosthesis placement and clinical complications [4]. In the end, despite a significant number of follow-up studies advocating for a relative short-term clinical success of the CHARITÉ Ò PRODISC Ò and similar devices [50], longterm results are still not convincing [6,50]. Such outcome seems independent on the treated low spine level, i.e.…”