Comparison of Mid- to Long-term Follow-up of Patient-reported Outcomes Measures After Single-level Lumbar Total Disc Arthroplasty, Multi-level Lumbar Total Disc Arthroplasty, and the Lumbar Hybrid Procedure for the Treatment of Degenerative Disc Disease

Scott-Young, Matthew; Lee, So Mang Simon; Nielsen, David; Rathbone, Evelyne; Rackham, Matthew; Hing, Wayne

doi:10.1097/brs.0000000000004253

Cited by 5 publications

(2 citation statements)

References 51 publications

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“…25 They warned to expect lateonset problems related to TDR in many patients. Fortunately, the results of the current study, as well as others with long-term follow-up, [26][27][28] have not fulfilled this prediction. In fact, there was only one removal occurring in the subset of 258 patients with a minimum 15-year follow-up, and this occurred in a patient whose subsequent surgery was due to trauma.…”

Section: Discussioncontrasting

confidence: 89%

Lumbar Total Disc Replacement Device Removals and Revisions Performed During a 20 Year Experience with 2,141 Patients

Guyer,

Blumenthal,

Shellock

et al. 2024

Spine

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Study Design: This was a retrospective study with prospective patient contact attempted to collect current data. Objective: The purpose was to investigate the incidence and reasons for lumbar total disc replacement (TDR) removal or revision. Summary of Background Data: A concern regarding lumbar TDR was safety, particularly the need for device removal or revision. This may be particularly important considering removal/revision requires repeat anterior exposure with increased risk of vascular injury. Methods: Data were collected for a series of 2,141 lumbar TDR patients beginning with the first case experience in 2000. Mean follow-up was 78.6 months. For each case of device removal/revision, the reason, duration from index surgery, and procedure performed were recorded. Results: Of 2,141 patients, 27 (1.26%) underwent TDR removal or revision. Device removal was performed in 24 patients (1.12%) while 3 patients underwent revision (0.14%). Of the 24 removals: 12 were due to migration and/or loosening, 3 developed problems post-trauma, 2 developed lymphocytic reaction to device materials, 2 had ongoing pain, and there was one case of each: TDR was too large, vertebral body fracture (osteoporosis), lytic lesion, device subsidence and facet arthrosis, and infection seeded from a chest infection 146 months post-TDR. The 3 revisions were for: Core repositioning (technique error), device repositioning after displacement, and core replacement due to wear/failure. With respect to timing, 37.0% of removals/revisions occurred within one month post-implantation. Of note, 40.7% of removals/revisions occurred in the first 25 TDR cases performed by individual surgeons. There was one significant vascular complication, occurring in a patient whose TDR was removed due to trauma. This was also the only patient among 258 with >15-year follow-up who underwent removal/revision. Conclusion: In this large consecutive series, 1.26% of TDRs were removed/revised. The low rate over a 20 year period supports the safety of these devices.

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Section: Discussioncontrasting

confidence: 89%

Lumbar Total Disc Replacement Device Removals and Revisions Performed During a 20 Year Experience with 2,141 Patients

Guyer,

Blumenthal,

Shellock

et al. 2024

Spine

View full text Add to dashboard Cite

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“…Because of this, 52.7% of surgeons surveyed communicated having reservations about the challenges of the revision surgery after L-TDR 23 . Overall revision rate rates in one study were reported to be 6-14% and the study noted risks of the procedure such as surgical site infections, major vessel bleeding, and pseudoarthrosis 39 . The revision burden for TDR was found to increase from 11.6% in 2005 to 24.3% in 2013 which is a critical value to weigh, especially when considering patient selection for the primary procedure 26 .…”

Section: Complications Of L-tdrmentioning

confidence: 99%

Lumbar Disc Arthroplasty: History and Analysis

C. Echevarria,

E. Carrier,

M. Abbas

et al. 2024

J Orthopedics & Orthopedic Surg

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Degenerative disc disease describes a ubiquitous condition involving the natural deterioration of an intervertebral disc. Conservative methods such as physical therapy and anti-inflammatories are recommended as first-line therapies for noninvasive management. However, when these interventions fail to reduce pain, surgical intervention is indicated. While laminectomies, discectomies, and spinal fusion procedures have been considered the standard treatment throughout the 20th century, the development of artificial discs has introduced an alternative surgical intervention in the form of total disc replacement. Initially, the novel devices garnered significant attention, thus leading to a rise in the rates of disc replacement procedures performed. However, several years after FDA approval of the first device, the prevalence of procedures steadily decreased. Several factors may have contributed to the downward trend, including the growing financial burden of hospitalization, stringent inclusion criteria indicating the procedure, and lack of provider familiarity and comfort with the procedure. Although the expected prevalence of disc arthroplasty remains unrealized, there is significant potential for an expanded role in the contemporary treatment of degenerative disc disease. This review illustrates the timeline and course of lumbar disc arthroplasty by describing its development, followed by its introduction in Europe and eventual arrival in the United States. The initial growth in popularity due to promising results is explained along with the surgery’s swift decline primarily due to lack of sufficient evidence promoting replacement, poor insurance coverage, lack of clear indications and complications. This review encapsulates all components and describes future directions and clinical value of lumbar disc arthroplasty.

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The use of diffusion tensor imaging in spinal pathology: a comprehensive literature review

Scullen,

Milburn,

Aria

et al. 2024

Eur Spine J

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Study design We reviewed the available literature systematically without meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Objective To evaluate contemporary literature on use of spinal diffusion tensor imaging(sDTI) in spinal pathology. Background sDTI reveals the location and functional state of critical long tracts and is a potentially useful adjunct in disease management. Methods Studies were included if they presented or discussed data from investigative or therapeutic procedures involving sDTI on human subjects in the setting of surgically amenable spinal pathology. Studies were excluded if they were (1) restricted to computational models investigating parameters using data not obtained clinically, (2) about cranial DTI methods, (3) about spinal pathology data not related to surgical management, (4) discussions or overviews of methods/techniques with minimal inclusion of objective experimental or clinical data. Results Degenerative pathologies of interest were restricted to either cervical myelopathy (22/29,75.9%) or lumbar spondylosis 7/29,24.1%). Mass-occupying lesions included intradural pathology and discussed preoperative (7/9,77.8%) and intraoperative imaging(2/9,22.2%) as an adjunct to surgery 22.2%. Traumatic pathology focused on spinal cord injury prognosis and severity grading. Conclusions sDTI seems useful in surgical decision making and outcome measurements and in establishing clinical prognoses over a wide range of surgical pathologies. Further research is warranted with longer follow-up and larger population sizes in a prospective and controlled protocol.

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Comparison of Mid- to Long-term Follow-up of Patient-reported Outcomes Measures After Single-level Lumbar Total Disc Arthroplasty, Multi-level Lumbar Total Disc Arthroplasty, and the Lumbar Hybrid Procedure for the Treatment of Degenerative Disc Disease

Cited by 5 publications

References 51 publications

Lumbar Total Disc Replacement Device Removals and Revisions Performed During a 20 Year Experience with 2,141 Patients

Lumbar Total Disc Replacement Device Removals and Revisions Performed During a 20 Year Experience with 2,141 Patients

Lumbar Disc Arthroplasty: History and Analysis

The use of diffusion tensor imaging in spinal pathology: a comprehensive literature review

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