European Spine Journal

, Volume 15, Issue 2, pp 183–195 | Cite as

Charité total disc replacement—clinical and radiographical results after an average follow-up of 17 years

  • Michael Putzier
  • Julia F. Funk
  • Sascha V. Schneider
  • Christian Gross
  • Stephan W. Tohtz
  • Cyrus Khodadadyan-Klostermann
  • Carsten Perka
  • Frank Kandziora
Original Article


A retrospective clinical–radiological study to evaluate the long-term outcome after artificial disc replacement was performed. The objective is to investigate long-term results after implantation of a modular type artificial disc prosthesis in patients with degenerative disc disease (DDD). Total disc replacement (TDR) is a surgical procedure intended to save segmental spinal function, and thus replace spondylodesis. Short-term results are promising, whereas long-term results are scarce. The Charité TDR is the oldest existing implant, therefore, the longest possible follow-up is presented here. Seventy-one patients were treated with 84 Charité TDRs types I–III. Indication for TDR was moderate to severe DDD. Fifty-three patients (63 TDRs) were available for long-term follow-up of 17 years. Evaluation included Oswestry disability index, visual analog scale, overall outcome score, plain and extension/flexion radiographs. Implantation of Charité TDR resulted in a 60% rate of spontaneous ankylosis after 17 years. No significant difference between the three types of prostheses was found concerning clinical outcome. Reoperation was necessary in 11% of patients. Although no adjacent segment degeneration was observed in the functional implants (17%), these patients were significantly less satisfied than those with spontaneous ankylosis. TDR, nowadays, is an approved procedure. Proof that long-term results of TDR implantation in DDD are at least as good as fusion results is still missing.

Key words

Artificial disc replacement Degenerative disc disease Lumbar spine 


  1. 1.
    Adams MA, Freeman BJC, Morrison HP, Nels IW, Dolan P (2000) Mechanical initiation of intervertebral disc degeneration. Spine 25(13):1625–1636CrossRefPubMedGoogle Scholar
  2. 2.
    Aota Y, Kumano K, Hirabayashi S (1995) Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8(6):464–473PubMedCrossRefGoogle Scholar
  3. 3.
    Bertagnoli R, Kumar S (2002) Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J 11(Suppl 2):S131–S136PubMedGoogle Scholar
  4. 4.
    Blumenthal SL, Ohnmeiss DD, Guyer R, Hochschuler S, McAfee P, Garcia R, Salib R, Yuan H, Lee C, Bertagnoli R, Bryan V, Winter R (2002) Artificial intervertebral discs and beyond: a North American Spine Society Annual Meeting symposium. Spine J 2(6):460–463CrossRefPubMedGoogle Scholar
  5. 5.
    Blumenthal SL, Ohnmeiss DD, Guyer RD, Hochschuler SH (2003) Prospective study evaluating total disc replacement: preliminary results. J Spinal Disord Tech 16(5):450–454CrossRefPubMedGoogle Scholar
  6. 6.
    Boden SD, Wiesel SW (1990) Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine 15(6):571–576PubMedCrossRefGoogle Scholar
  7. 7.
    Buettner-Janz K, Schellnack K, Zippel H, Conrad P (1988) [Experience and results with the SB-Charité lumbar intervertebral endoprosthesis]. Z Klin Med 43:1785–1789Google Scholar
  8. 8.
    Buettner-Janz K, Hahn S, Schikora K, Link HD (2002) [Basic principles of successful implantation of the SB Charite model LINK intervertebral disk endoprosthesis]. Orthopäde 31(5):441–453CrossRefPubMedGoogle Scholar
  9. 9.
    Butler D, Trafimow JH, Andersson GB, et al (1990) Discs degenerate before facets. Spine 15:111–113PubMedCrossRefGoogle Scholar
  10. 10.
    Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, Reading AE (1985) Pain measurement: an overview. Pain 22:1–31CrossRefPubMedGoogle Scholar
  11. 11.
    Cinotti G, David T, Postacchini F (1996) Results of disc prosthesis after a minimum follow-up period of 2 years. Spine 21(8):995–1000CrossRefPubMedGoogle Scholar
  12. 12.
    David T (1993) Lumbar disc prosthesis. Surgical technique, indications and clinical results in 22 patients with a minimum of 12 months follow-up. Eur Spine J 1:254–259CrossRefPubMedGoogle Scholar
  13. 13.
    Delamarter RB, David M, Kanim A, Linda E, Bae H (2003) ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 28(Suppl 20):S167–S175CrossRefPubMedGoogle Scholar
  14. 14.
    Dooris AP, Goel VK, Grosland NM, Gilbertson LG, Wilder DG (2001) Load-sharing between anterior and posterior elements in a lumbar motion segment implanted with an artificial disc. Spine 26(6):E122–E129CrossRefPubMedGoogle Scholar
  15. 15.
    Dunlop R, Adams MA, Hutton WC (1984) Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br 66:706–710PubMedGoogle Scholar
  16. 16.
    Eck JC, Humphreys SC, Hodges SD (1999) Adjacent-segment degeneration after lumbar fusion: a review of clinical, biomechanical, and radiologic studies. Am J Orthop 28:336–340PubMedGoogle Scholar
  17. 17.
    Enker P, Steffee A, Mcmillin C, Keppler L, Biscup R, Miller S (1993) Artificial disc replacement. Preliminary report with a 3-year minimum follow-up. Spine 18(8):1061–1070PubMedCrossRefGoogle Scholar
  18. 18.
    Etebar S, Cahill DW (1999) Risk factors for adjacent-segment failure following lumbar fication with rigid instrumentation for degenerative instability. J Neurosurg 90:163–169PubMedGoogle Scholar
  19. 19.
    Fairbank JCT, Couper J, Davies J, O’Brien J (1980) The oswestry low back pain disability questionnaire. Physiotherapy 8:271Google Scholar
  20. 20.
    Griffith SL, Shelokov AP, Buttner-Janz K, LeMaire JP, Zeegers WS (1994) A multicenter retrospective study of the clinical results of the LINK SB Charite intervertebral prosthesis. The initial European experience. Spine 19(16):1842–1849PubMedCrossRefGoogle Scholar
  21. 21.
    Hochschuler SH, Ohnmeiss DD, Guyer RD, Blumenthal SL (2002) Artificial disc: preliminary results of a prospective study in the United States. Eur Spine J 11(Suppl 2):S106–S110PubMedGoogle Scholar
  22. 22.
    Hopf C, Heeckt H, Beske C (2002) [Disc replacement with the SB Charite endoposthesis—experience, preliminary results and comments after 35 prospectively performed operations]. Z Orthop Ihre Grenzgeb 140(5):485–491CrossRefPubMedGoogle Scholar
  23. 23.
    Kandziora F, Pflugmacher R, Scholz M, Schnake K, Lucke M, Schröder R, Mittlmeier T (2001) Comparison between sheep and human cervical spines. An anatomic, radiographic bone mineral density, and biomechanical study. Spine 26(9):1028–1037CrossRefPubMedGoogle Scholar
  24. 24.
    Kumar MN, Jacquot F, Hall H (2001) Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J 10:309–313CrossRefPubMedGoogle Scholar
  25. 25.
    de Kleuver M, Oner FC, Jacobs WC (2003) Total disc replacement for chronic low back pain: background and a systematic review of the literature. Eur Spine J 12(2):108–116PubMedGoogle Scholar
  26. 26.
    Lee CK (1988) Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13:375–377PubMedCrossRefGoogle Scholar
  27. 27.
    Lee CK, Parsons JR, Langrana LA, Zimmermann MC (1992) Relative efficacy of the artificial disc versus spinal fusion. In: Weinstein JN (ed) Clinical efficacy and outcome in the diagnosis and treatment of low back pain. Raven Press, New York, pp 237–244Google Scholar
  28. 28.
    Lehmann TR, Spratt KF, Tozzi JE, et al (1987) Long-term follow-up of lower lumbar fusion patients. Spine 12:97–104PubMedCrossRefGoogle Scholar
  29. 29.
    Lemaire JP, Skalli W, Lavaste F, Templier A, Mendes F, Diop A, Sauty V, Laloux E (1997) Intervertebral disc prosthesis. Results and prospects for the year 2000. Clin Orthop 337:64–76 (Review)PubMedCrossRefGoogle Scholar
  30. 30.
    Link HD (2002) History, design and biomechanics of the LINK SB Charité artificial disc. Eur Spine J 11(Suppl 2):S98–S105PubMedMathSciNetGoogle Scholar
  31. 31.
    Manzini CU, Spina V, Mascia MT, Magistro R, Carpenito G, Ferri C (2004) [Diffuse post-traumatic calcification of the anterior longitudinal ligamentum of cervical and dorsal spine]. Reumatismo 56(2):114–117PubMedGoogle Scholar
  32. 32.
    Mayer HM, Wiechert K, Korge A, Qose I (2002) Minimally invasive total disc replacement: surgical technique and preliminary clinical results. Eur Spine J 11(Suppl 2):S124–S130PubMedGoogle Scholar
  33. 33.
    McAfee PC, Cunningham BW, Devine J, Williams E, Yu-Yahiro J (2003) Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech 16(4):384–389PubMedGoogle Scholar
  34. 34.
    McAfee PC, Fedder IL, Saiedy S, Shucosky EM, Cunningham BW (2003) SB Charite disc replacement: report of 60 prospective randomized cases in a US center. J Spinal Disord Tech 16(4):424–433PubMedGoogle Scholar
  35. 35.
    Meyerding HW (1956) Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg 26:566–591PubMedGoogle Scholar
  36. 36.
    Miyamoto S, Kuratsu S, Yonenobu K, Ono K (1992) Evaluation of cell proliferating potentials in ossification of the spinal ligaments by argyrophilic nucleolar organizer region (AgNOR) staining. In: Kurokawa T (ed) Annual report of the investigation committee for ossification of the spinal ligaments under the auspices of Japanese ministry of health and welfare. Department of Orthopaedics, University of Tokyo, Japan, pp 160–165Google Scholar
  37. 37.
    Odom GL, Finney W, Woodhall B (1958) Cervical disc lesions. JAMA 166:23–28Google Scholar
  38. 38.
    Oegema TR Jr, Bradford DS (1991) The interrelationship of facet joint osteoarthritis and degenerative disc disease. Br J Rheumatol 30:16–20PubMedCrossRefGoogle Scholar
  39. 39.
    van Ooij A, Oner FC, Verbout AJ (2003) Complications of artificial disc replacement a report of 27 patients with the SB Charite disc. J Spinal Disord Tech 16(4):369–383PubMedGoogle Scholar
  40. 40.
    Pope MH, Wilder DG, Matteri RE, Frymoyer JW (1977) Experimental measurements of vertebral motion under load. Orthop Clin North Am 8(1):155–167PubMedGoogle Scholar
  41. 41.
    Rahm MD, Hall MD (1996) Adjacent-segment degeneration after lumbar fusion with instrumentation: A retrospective study. J Spinal Disord 9(5):392–400PubMedCrossRefGoogle Scholar
  42. 42.
    Ray CD (1992) The artificial disc. In: Weinstein JN (ed) Clinical efficacy and outcome in the diagnosis of low back pain. Raven Press, New York, pp271–278Google Scholar
  43. 43.
    Schwarzer AC, Aprill CN, Derby R, et al. (1994) The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine 19:801–806PubMedCrossRefGoogle Scholar
  44. 44.
    Steffee AD (1992) The Steffee artificial disc. In: Weinstein JN (ed) Clinical efficacy and outcome in the diagnosis of low back pain. Raven Press, New York, pp 245–257Google Scholar
  45. 45.
    Tropiano P, Huang RC, Girardi FP, Marnay T (2003) Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year. J Spinal Disord Tech 16(4):362–368PubMedGoogle Scholar
  46. 46.
    Zeegers WS, Bohnen LM, Laaper M, Verhaegen MJ (1999) Artificial disc replacement with the modular type SB Charite III: 2-year results in 50 prospectively studied patients. Eur Spine J 8(3):210–217CrossRefPubMedGoogle Scholar
  47. 47.
    Zigler JE, Burd TA, Vialle EN, Sachs BL, Rashbaum RF, Ohnmeiss DD (2003) Lumbar spine arthroplasty: early results using the ProDisc II: a prospective randomized trial of arthroplasty versus fusion. J Spinal Disord Tech 16(4):352–361PubMedGoogle Scholar
  48. 48.
    Zippel H (1991) “Charité modular”: conception, experience and results. In: Weinstein JN, Mayer HM, Weigel K (eds) The artificial disc. Springer, Berlin Heidelberg New York, pp 69–78Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Michael Putzier
    • 1
  • Julia F. Funk
    • 1
  • Sascha V. Schneider
    • 1
  • Christian Gross
    • 1
  • Stephan W. Tohtz
    • 1
  • Cyrus Khodadadyan-Klostermann
    • 1
  • Carsten Perka
    • 1
  • Frank Kandziora
    • 1
  1. 1.Center for Musculoskeletal SurgeryCharité—University Medicine BerlinBerlinGermany

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