Facet Joint and Adjacent Level Degeneration Following Total Lumbar Disc Replacement: A Prospective Clinical, X-Ray, and MRI Investigation

Siepe, Christoph J.; Sauri-Barraza, Jose-Carlos; Zelenkov, Petr; Szeimies, Ulrike; Stäbler, Axel; Beisse, Rudolf; Korge, Andreas; Mayer, Michael H.

doi:10.1016/j.spinee.2010.07.241

Cited by 3 publications

(5 citation statements)

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“…Our results showed no significant relationship between the occurrence of residual-mobility and the occurrence of ASD. This is similar to the results reported in the prospective study of Siepe et al 22 (n = 91) and a randomized controlled trial by Zigler et al 12 (n = 261), both with 4 to 5 years of mean follow-up.…”

Section: Discussionsupporting

confidence: 90%

“…The occurrence of FJD was associated with significantly lower VAS and ODI scores. This may explain why in our study, as in many other studies, 12,20,22 no significant associations were found between ASD and clinical outcome. FJD might be a stronger factor influencing clinical outcomes after TDR than ASD.…”

Section: Discussionsupporting

confidence: 58%

“…Therefore, we could not investigate a possible association between FJD and the occurrence of residual-mobility or clinical outcome. Siepe et al 22 reported a significant increase of FJD at the index level after TDR and a significant decrease in ROM at the same level. The occurrence of FJD was associated with significantly lower VAS and ODI scores.…”

Section: Discussionmentioning

confidence: 96%

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Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement

Kitzen

Vercoulen

Schotanus

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Total disc replacement (TDR) has been introduced in order to preserve segmental motion and thus reduce adjacent segment disease (ASD) as seen after spinal fusion. However, it is uncertain whether these presumed beneficial effects remain. The aim of this study was to evaluate the long-term incidence of ASD and residual-mobility in relation to clinical outcome. Methods: A total of 210 patients treated with lumbar TDR for degenerative disc disease were invited for follow-up. ASD was reported in case of severe degeneration in an adjacent disc at latest follow-up, or if an increase in disc degeneration was observed in these adjacent segments as compared to direct postoperative radiographs. Residual-mobility of the TDR was defined as a minimal rotation of 4.6° on flexion-extension radiographs. Patient-reported outcome measures were obtained. Results: Fifty-seven patients (27.1%) were lost to follow-up. In 32 patients (15.3%) a revision by spinal fusion had been performed. In 20 patients this revision had occurred ≥5 years after TDR and were included. Consequently, 141 patients were available for analysis (mean follow-up of 16.7 years). Residual-mobility was noted in 38.0%. No significant associations were observed between residual-mobility and the occurrence of ASD, or with clinical outcome. In addition, ASD and clinical outcome were not related either. Conclusions: It appears that long-term preservation of motion after TDR is met for only a third of patients. However, residual-mobility is not associated with the occurrence of ASD, and both residual-mobility and ASD do not appear to be related to long-term clinical outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 96%

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Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement

Kitzen

Vercoulen

Schotanus

et al. 2020

Global Spine Journal

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“…Siepe et al con rmed facet joint pain by uoroscopically guided spine in ltrations in 9.1% patients after L4/L5 TDR, 28.1% after L5/S1 TDR, and 60% after bi-segmental TDR, using ProDisc II 23 . They in a later study observed that progression of FJD was present in 20% of all facet joints at 53.4 months follow-up and more common at lumbosacral junction, and progression of FJD was associated with lower ROM at the index level and inferior VAS and ODI scores 24 . A small portion of patients with facet joint complains eventually received revision surgery.…”

Section: Discussionmentioning

confidence: 93%

Combined effect of artificial cervical disc replacement and facet tropism on the index-level facet joints: a finite element study

Xiao

Zhang

et al. 2023

Preprint

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Objective The purpose of this study was to assess the impact of facet tropism on the facet contact force and facet capsule strain after artificial cervical disc replacement (ACDR). Methods A finite element model was constructed from computed tomography (CT) scans of a 28-year-old male volunteer. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level. C5/C6 ACDR was simulated in all models. A 75 N follower load and 1 N⋅m moment was applied to the odontoid process to initiate flexion, extension, lateral bending, and axial rotation, and the range of motions, facet contact forces, and facet capsule strains were recorded. Results In the severe asymmetrical model, the right-side FCF increased considerably under extension, right bending, and left rotation compared with the symmetrical model after C5/C6 ACDR. The ride-side FCFs of the severe asymmetrical model under extension, right bending, and left rotation were about 1.7, 3.1, and 1.8 times of those of the symmetrical model, respectively. The facet capsule strains of both the moderate and severe asymmetrical models increased significantly compared with those of the symmetrical model after C5/C6 ACDR. The left-side capsule strains of the severe asymmetrical model were 2.1, 2.4, 1.6, and 8.5 times of those of the symmetrical model under left bending, right bending, left rotation, and right rotation, respectively. The right-side capsule strains of the severe asymmetrical model were 6.3, 1.6, 3.7, and 2.2 times of those of the symmetrical model under left bending, right bending, left rotation, and right rotation, respectively. The stress distribution on the facet surface in the asymmetrical models was different from that in the symmetrical model. Conclusions The existence of facet tropism could considerably increase facet contact force and facet capsule strain after ACDR, especially under extension, lateral bending, and rotation. Facet tropism also could result in abnormal stress distribution on the facet joint surface and facet joint capsule. Such abnormality might be a risk factor for post-operative facet joint degeneration progression after ACDR, making facet tropism noteworthy when ACDR was considered as the surgical option.

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“…In order to avoid those fusion-related side effects, lumbar total disc replacement (TDR) has been introduced. However, TDR has also been associated with drawbacks, such as subsidence, dislocation, or malposition of the implant [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Subsidence after total lumbar disc replacement is predictable and related to clinical outcome

et al. 2020

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Purpose As yet, there are no studies describing a relationship between radiographic subsidence after lumbar total disc replacement (TDR) and patient symptoms. To investigate if subsidence, in terms of penetrated bone volume or angular rotation over time (ΔPBV and ΔAR), is related to clinical outcome. To assess if subsidence can be predicted by position implant asymmetry (IA) or relative size of the TDR, areal undersizing index (AUI) on direct post-operative radiographs. Methods Retrospective cohort study consists of 209 consecutive patients with lumbar TDR for degenerative disc disease. A three-dimensional graphical representation of the implant in relation to the bony endplates was created on conventional radiographs. Consequently, the PBV, AR, IA and AUI were calculated, direct post-operative (DPO) and at last follow-up (LFU). For clinical evaluation, patients with substantial pain (VAS ≥ 50) and malfunction (ODI ≥ 40) were considered failures. Results At a mean follow-up of 16.7 years, 152 patients (73%) were available for analysis. In 32 patients, revision by spinal fusion had been performed. Both ΔAR (4.33° vs. 1.83°, p = 0.019) and ΔPBV (1448.4 mm 3 vs. 747.3 mm 3 , p = 0.003) were significantly higher in the failure-compared to the success-group. Using ROC curves, thresholds for symptomatic subsidence were defined as ΔPBV ≥ 829 mm 3 or PBV-LFU ≥ 1223 mm 3 [area under the curve (AUC) 0.723, p = 0.003 and 0.724, p = 0.005, respectively]. Associations between symptomatic subsidence and AUI-DPO ≥ 0.50 (AUC 0.750, p = 0.002) and AR-DPO ≥ 3.95° (AUC 0.690, p = 0.022) were found. Conclusion Subsidence of a TDR is associated with a worse clinical outcome. The occurrence of subsidence is higher in case of incorrect placement or shape mismatch.

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Facet Joint and Adjacent Level Degeneration Following Total Lumbar Disc Replacement: A Prospective Clinical, X-Ray, and MRI Investigation

Cited by 3 publications

References 0 publications

Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement

Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement

Combined effect of artificial cervical disc replacement and facet tropism on the index-level facet joints: a finite element study

Subsidence after total lumbar disc replacement is predictable and related to clinical outcome

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