Prevalence of Lumbar Total Disc Replacement Candidates in a Community-based Spinal Surgery Practice

Fras, Christian I.; Auerbach, Joshua D.

doi:10.1097/bsd.0b013e3180621589

Cited by 11 publications

(5 citation statements)

References 21 publications

(15 reference statements)

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“…Changing them might allow conceivably more patients to be considered for lumbar TDR [18]. Is this desirable?…”

Section: Discussionmentioning

confidence: 99%

“…Huang et al reviewed a single-surgeon series of 100 consecutive lumbar patients including solely 5 TDR cases [17]. Fras and Auerbach presented a retrospective 15-months record review of patients in a private clinic indicating that less than 5% of 190 consecutive spine surgery patients were free of contraindications, qualifying them to be potential candidates for TDR [18]. Applying similar criteria Chin [15] evaluated a population of a university outpatient clinic reporting 5-9% of patients without contraindications.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Zweig

Hemmeler

Aghayev

et al. 2011

BMC Musculoskelet Disord

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BackgroundCurrently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR.MethodsBetween March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D).Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling.ResultsDemographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower.ConclusionsDespite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal candidates for the procedure.

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“…Changing them might allow conceivably more patients to be considered for lumbar TDR [18]. Is this desirable?…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Zweig

Hemmeler

Aghayev

et al. 2011

BMC Musculoskelet Disord

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show abstract

“…Changing them might allow conceivably more patients or better selected patients to be considered for lumbar TDR [29]. Is this desirable?…”

Section: Discussionmentioning

confidence: 99%

Influence of preoperative leg pain and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

et al. 2011

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Purpose Currently, many pre-conditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). Radiculopathy is one among them. In Switzerland it is left to the surgeon's discretion when to operate if he adheres to a list of pre-defined indications. Contraindications, however, are less clearly specified. We hypothesized that, the extent of pre-operative radiculopathy results in different benefits for patients treated with monosegmental lumbar TDR. We used patient perceived leg pain and its correlation with physician recorded radiculopathy for creating the patient groups to be compared. Methods The present study is based on the dataset of SWISSspine, a government mandated health technology assessment registry. Between March 2005 and April 2009, 577 patients underwent either mono-or bi-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. A total of 416 cases with a mono-segmental procedure were included in the study. The data collection consisted of pre-operative and follow-up data (physician based) and clinical outcomes (NASS form, EQ-5D). A receiver operating characteristic (ROC) analysis was conducted with patients' self-indicated leg pain and the surgeon-based diagnosis ''radiculopathy'', as marked on the case report forms. As a result, patients were divided into two groups according to the severity of leg pain. The two groups were compared with regard to the pre-operative patient characteristics and pre-and post-operative pain on Visual Analogue Scale (VAS) and quality of life using general linear modeling. ResultsThe optimal ROC model revealed a leg pain threshold of 40 B VAS [ 40 for the absence or the presence of ''radiculopathy''. Demographics in the resulting two groups were well comparable. Applying this threshold, the mean preoperative leg pain level was 16.5 points in group 1 and 68.1 points in group 2 (p \ 0.001). Back pain levels differed less with 63.6 points in group 1 and 72.6 in group 2 (p \ 0.001).Pre-operative quality of life showed considerable differences with an 0.44 EQ-5D score in group 1 and 0.29 in group 2 (p \ 0.001, possible score range -0.6 to 1). At a mean followup time of 8 months, group 1 showed a mean leg pain improvement of 3.6 points and group 2 of 41.1 points (p \ 0.001). Back pain relief was 35.6 and 39.1 points, respectively (p = 0.27). EQ-5D score improvement was 0.27 in group 1 and 0.41 in group 2 (p = 0.11). ConclusionsPatients labeled as having radiculopathy (group 2) do mostly have pre-operative leg pain levels C 40. Applying this threshold, the patients with preoperative leg pain do also have more severe back pain and a considerably lower quality of life. Their net benefit from the lumbar TDR is higher and they do have similar postoperative back and leg pain levels as well as the quality of life as patients without pre-operative leg pain. Although randomized controlled trials are required to confirm these findings, they put leg pain and radiculopathy into perspective as absolute contr...

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“…Ergebnisse n Nur ca. 5% der Patienten, die einer Operation bedürfen aufgrund von degenerativen Lendenwirbelsäulenveränderungen, sind potenzielle Kandidaten für eine lumbale Bandscheibenendoprothese [2,5].…”

Section: Total Disc Replacement -A Critical Updateunclassified

Bandscheibenendoprothesen – Ein kritisches Update

Scholz¹,

Pingel²,

Hoffmann³

et al. 2009

OP-JOURNAL

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Prevalence of Lumbar Total Disc Replacement Candidates in a Community-based Spinal Surgery Practice

Cited by 11 publications

References 21 publications

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Influence of preoperative leg pain and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Bandscheibenendoprothesen – Ein kritisches Update

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