Degenerative Changes of Discs and Facet Joints in Lumbar Total Disc Replacement Using ProDisc II

Park, Chun-Kun; Ryu, Kyeong‐Sik; Jee, Won-Hee

doi:10.1097/brs.0b013e31817b8fed

Cited by 77 publications

(55 citation statements)

References 25 publications

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“…"SKIPPED" LEVEL DISC DEGENERATIONbody arthroplasty techniques were used to facilitate, in premise, motion preservation (42,44,45). In fact, using such a model for reference may be more appropriate, because, as some investigators contend, the escalating severity of disc degeneration has been associated with an increase in segmental motion (37,38).…”

Section: Discussionmentioning

confidence: 99%

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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Objective. Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD).Methods. As part of a large genetics-based study in southern Chinese individuals (n ‫؍‬ 1,989), a crosssectional analysis was performed in subjects exhibiting disc degeneration in >2 levels (n ‫؍‬ 838) who were then categorized as having SLDD (n ‫؍‬ 174) or non-SLDD (contiguous, multilevel; n ‫؍‬ 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed.Results. Overall, 8.7% of the whole population (n ‫؍‬ 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n ‫؍‬ 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04-2.10, P ‫؍‬ 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78-4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P ‫؍‬ 0.004) and/or a history of back injury (P ‫؍‬ 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups.Conclusion. To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.

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Section: Discussionmentioning

confidence: 99%

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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“…A preoperatively existent high-grade facet joint degeneration (FJD) can especially lead to inferior clinical results; therefore, FJD was suggested as a contraindication for this procedure [18]. However, facet joint forces may increase after TDR followed by a de novo development or the progression of preoperatively existing initial FJD in a relevant percentage of patients (20-36 %) with a resulting inferior clinical outcome [19][20][21][22][23]. In a prospective study, Siepe et al [23] found that FJD appeared more frequently at the index level compared with the adjacent levels and significantly more frequently at the lumbosacral junction compared with the levels above it.…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, patients with FJD progression after TDR present with inferior clinical results a few month postoperatively [23], which suggests that FJD itself may not be the only cause of pain or functional impairment. Several factors, such as malposition in the frontal plane, the grade of restoration of the disc height by segmental distraction, or the consecutive changes of the local sagittal curve with increased segmental lordosis, may affect facet joint forces after TDR [20,25,26]. In our probabilistic finite element model (FEM) analysis [27], we demonstrated that a segmental misalignment in the sagittal plane after TDR with an anterior or posterior shift of the superior vertebra leads to a significant increase in facet joint contact or capsule tensile forces.…”

Section: Introductionmentioning

confidence: 99%

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

et al. 2013

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Purpose The aim of the second part of the study was to investigate the influence of parameters that lead to increased facet joint contact or capsule tensile forces (disc height, lordosis, and sagittal misalignment) on the clinical outcome after total disc replacement (TDR) at the lumbosacral junction. Methods A total of 40 patients of a prospective cohort study who received TDR because of degenerative disc disease or osteochondrosis L5/S1 were invited to an additional follow-up for clinical (ODI and VAS for overall, back, and leg pain) and radiographic analysis (a change in disc height, lordosis, or sagittal vertebral misalignment compared with the preoperative state). Based on the final ODI, patients were retrospectively distributed into groups N (normal: \25 %) or F (failure C25 %) for radiographic parameter comparison. A correlation analysis was performed between the clinical and radiological results. Results A total of 34 patients were available at a mean follow-up of 59.5 months. Both groups (N = 24; F = 10 patients) presented a significant improvement in overall pain, back pain, and ODI over time. At the final follow-up, higher clinical scores correlated with a larger disc height, increased lordosis, and posterior translation of the superior vertebra, which was also reflected by significant differences in these parameters in the group comparison. Conclusions Parameters associated with increased facet joint capsule tensile forces lead to an inferior clinical outcome at mid-term follow-up. When performing TDR, we therefore suggest avoiding iatrogenic posterior translation and overdistraction (and consecutive lordosis).

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“…Controversy still exists regarding whether TDR can prevent adjacent segment degeneration in the long term [23][24][25][26][27]. To assess the role of any new treatment method, long-term clinical results need to be evaluated in clinical studies with adequately sized patient cohorts and sufficient long-term results.…”

Section: Introductionmentioning

confidence: 99%

An 11-year minimum follow-up of the Charite III lumbar disc replacement for the treatment of symptomatic degenerative disc disease

Hai

Kong

et al. 2015

Eur Spine J

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Purpose To report our 11-year minimum clinical and radiological outcomes, as well as complications of the Charite III total disc replacement (TDR). Methods A total of 35 patients indicated for total disc replacement were implanted with the Charite III prosthesis. Clinical evaluation included visual analog scale (VAS) for back pain and the Oswestry disability index (ODI). Radiological parameters of intervertebral disc height (IDH), range of motion (ROM), lumbar lordosis, lumbar scoliosis and prosthesis position were evaluated. Complications and reoperation rates were also assessed. Results Thirty-two patients had a minimum 11-year follow-up, and 33 prostheses were implanted. The mean follow-up time was 11.8 years, ranging from 11.3 to 13.8 years. Twenty-eight patients (87.5 %) had a successful outcome, as defined by the FDA. Reoperation was performed in 2 patients for adjacent segment degeneration and pedicle fracture (1 case each). Both VAS and ODI scores showed significant improvement compared to baseline. At the final follow-up, the ROM of both the index-and adjacent-level showed an obvious decrease. The IDH of the index level showed a tendency to decrease, but the difference was not significant. The IDH of adjacent levels were not significantly affected by the surgery. Mean lumbar lordosis was increased at the final follow-up, and lumbar scoliosis over 3°was observed in 12 patients (37.5 %), with a mean angle of 5.6°(range 3°-12°). Of all 35 prostheses, 15 were left-shifted, 3 were right-shifted and 14 were just in the middle. In the coronal plane, 25 were rated as ideally placed, 5 were discretely shifted, 4 were slightly shifted and 1 was markedly shifted. In the sagittal plane, only 12 prostheses were rated as ideally placed, 14 were discretely shifted and 9 were suboptimally placed. Prosthesis subsidence was noted in 3 (9.4 %) patients (the subsidence distances were 3.1, 4.2 and 2.8 mm, respectively). Heterotopic ossification was detected in 25 segments (71.4 %), consisting of Class-I heterotopic ossification in 7 segments (20.0 %), Class-II in 9 segments (25.7 %), and Class-III in 9 segments (25.7 %). Class-IV heterotopic ossification was not observed. Conclusion The cumulative survival was 100 % at a mean follow-up of 11.8 years. Clinical and radiological results were satisfactory and long-term clinical results were maintained for a mean follow-up of 11.8 years. Reoperation and complication rates are acceptable, and our study does not substantiate the fear of reoperation or late complications. The results of our long-term follow-up indicate that, with strict indication, TDR is a safe and effective procedure as an alternative to lumbar fusion.

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Degenerative Changes of Discs and Facet Joints in Lumbar Total Disc Replacement Using ProDisc II

Cited by 77 publications

References 25 publications

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

An 11-year minimum follow-up of the Charite III lumbar disc replacement for the treatment of symptomatic degenerative disc disease

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