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Total disc replacement for lumbar degenerative disc disease: single centre 20 years experience

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Abstract

Purpose

To report clinical and radiographic outcomes, rate of complications and influence on spinal alignment on long-term follow-up (FU) of patients who underwent lumbar total disc arthroplasty (TDR), bringing some evidence to determine the profile of the most well-suited patients for TDR.

Methods

A retrospective review of patients underwent TDR for low back pain from degenerative disc disease (DDD) resistant to conservative treatment was performed. Demographic features, surgical data, clinical and radiographic outcomes, complications and spinopelvic parameters were evaluated.

Results

Thirty patients (32 TDR) were included with a mean FU of 164 ± 36.5 months. The clinical outcomes measured by visual analogue scale and Oswestry Disability Index showed a significant improvement between preoperative and 1-year FU (p < 0.01). No significant temporal variance has been identified between 1-year and long-term follow-up (p > 0.05). The surgical revision rate was 10%. The overall rate of complications was 20%. At final follow-up, the mobility of the prosthesis was preserved in 68.75% of the cases, and 73.3% of the patients were globally well aligned.

Conclusion

The optimal surgical indication is crucial to achieve excellent clinical and radiological outcomes. According to the literature and to our experience, we underline the importance of a coronal deformity < 15° Cobb angle and a Roussouly type 1 or 2 as the profile of the most well-suited patient for TDR. Our long-term results confirm the existing evidence about efficacy and safety of TDR as a reliable option, in optimal surgery indication, to treat DDD.

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, MI, Italy

    Carlo Formica & Pedro Berjano

  2. Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy

    Andrea Zanirato, Stefano Divano, Marco Basso, Luca Cavagnaro, Mattia Alessio Mazzola, Lamberto Felli & Matteo Formica

  3. Anatomic Pathology, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy

    Valerio Gaetano Vellone

  4. Department of Internal Medicine, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy

    Maddalena Mastrogiacomo

  5. Biotherapy Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy

    Maddalena Mastrogiacomo

Authors
  1. Carlo Formica
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  2. Andrea Zanirato
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  3. Stefano Divano
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  4. Marco Basso
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  6. Mattia Alessio Mazzola
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  8. Maddalena Mastrogiacomo
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  9. Pedro Berjano
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  10. Lamberto Felli
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  11. Matteo Formica
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Correspondence to Matteo Formica.

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Formica, C., Zanirato, A., Divano, S. et al. Total disc replacement for lumbar degenerative disc disease: single centre 20 years experience. Eur Spine J 29, 1518–1526 (2020). https://doi.org/10.1007/s00586-019-06100-3

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  • DOI: https://doi.org/10.1007/s00586-019-06100-3

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