Association of facet tropism and progressive facet arthrosis after lumbar total disc replacement using ProDisc-L®

Abstract

Purpose The purpose of this retrospective study was to examine the association of facet tropism and progressive facet arthrosis (PFA) after lumbar total disc replacement (TDR) surgery using ProDisc-L Ò . Methods A total of 51 segments of 42 patients who had undergone lumbar TDR using ProDisc-L Ò between October 2003 and July 2007 and completed minimum 36-month follow-up period were retrospectively reviewed. The changes of facet arthrosis were categorized as non-PFA and PFA group. Comparison between non-PFA and PFA group was made according to age, sex, mean follow-up duration, grade of preoperative facet arthrosis, coronal and sagittal prosthetic position and degree of facet tropism. Multiple logistic regression analysis was also performed to analyze the effect of facet tropism on the progression of facet arthrosis. Results The mean age at the surgery was 44.43 ± 11.09 years and there were 16 males and 26 females. The mean follow-up period was 53.18 ± 15.79 months. Non-PFA group was composed of 19 levels and PFA group was composed of 32 levels. Age at surgery, sex proportion, mean follow-up period, level of implant, grade of preoperative facet arthrosis and coronal and sagittal prosthetic position were not significantly different between two groups (p = 0. 264, 0.433, 0.527, 0.232, 0.926, 0.849 and 0.369, respectively). However, PFA group showed significantly higher degree of facet tropism (7.37 ± 6.46°) than that of non-PFA group (3.51 ± 3.53°) and p value was 0.008. After adjustment for age, sex and coronal and sagittal prosthetic position, multiple logistic regression analysis revealed that facet tropism of more than 5°was the only significant independent predictor of progression of facet arthrosis (odds ratio 5.39, 95 % confidence interval 1.251-19.343, p = 0.023). Conclusions The data demonstrate that significant higher degree of facet tropism was seen in PFA group compared with non-PFA group and facet tropism of more than 5°had a significant association with PFA after TDR using ProDisc-L Ò .

Biomechanical function of a balloon nucleus pulposus replacement system: A human cadaveric spine study

“…Typical surgical methods include simple discectomy and/or spinal fusion with or without spinal instrumentation. Recent innovative motion‐sparing surgical techniques include artificial disc replacement technologies, posterior dynamic stabilization, and disc nucleus replacement (DNR) . The principles underlying these procedures are related to either ablation of IVD structures considered as “pain generators” or to stabilization of abnormal motion patterns …”

Interrelation of tropism and angulation parameters of facet joints and results of stabilization surgeries for degenerative diseases of the lumbar spine

“…В спинальной хирургии выполняют различные оперативные вмешательства при дегенеративных заболеваниях дугоотростчатых суставов -от минимально-инвазивных пункционных методик до парциальной или тотальной фасетэктомии с ригидной стабилизацией, результаты которых неоднозначны [1][2][3]17]. Это, в первую очередь, связано с отсутствием объективных показаний к выбору вида оперативного лечения без учета индивидуальных анатомических особенностей дугоотростчатых суставов [18].…”

“…Изучение взаимосвязи индивидуальных предоперационных параметров дугоотростчатых суставов и результата хирургического вмешательства частично анализируют при выполнении тотальной артропластики поясничного отдела. Так, Shin et al [18] при изучении данных 42 пациентов с имплантацией протеза диска «ProDisc-L» установили прямую корреляционную взаимосвязь тропизма дугоотростчатых суставов и развития выраженного клинически значимого спондилоартроза после эндопротезирования. Также встречаются исследования, указывающие на значительное прогрессирование дегенеративных изменений дугоотростчатых суставов после тотальной артропластики без детализации дооперационных изменений в суставе.…”

“…Также встречаются исследования, указывающие на значительное прогрессирование дегенеративных изменений дугоотростчатых суставов после тотальной артропластики без детализации дооперационных изменений в суставе. Shim et al [19] [18,19,21] о роли величины фасеточного угла и тропизма дугоотростчатых суставов в прогнозировании отдаленного послеоперационного клинического исхода у пациентов с дегенеративными заболеваниями нижнепоясничных сегментов.…”

We Need to Talk about Lumbar Total Disc Replacement

“…337 Of note, the clinical implications of PFA following LTDR using the ProDisc-L were not discussed in the aforementioned series, 337 which remains (to our knowledge) the only publication describing postimplantation facet arthrosis using this LAD, thus emphasizing the need for incidence data in this respect.…”