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Lumbar total disc replacement: predictors for long-term outcome

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Abstract

Purpose

We aimed to identify patient characteristics associated with favourable long-term outcomes after lumbar total disc replacement (TDR).

Methods

We analysed a cohort of 82 patients with degenerative disc and chronic low back pain (LBP) who were treated with TDR and originally participated in a randomised trial comparing TDR and multidisciplinary rehabilitation. Potential predictors were measured at baseline, and the outcomes assessed 8 years after they received allocated treatment. Outcome measures were dichotomised according to whether the participants achieved a clinically important functional improvement (15 points or more on the Oswestry Disability Index, ODI) (primary outcome) and whether they were employed at 8-year follow-up (secondary outcome). Associations between potential predictors and outcomes were modelled using logistic regression. For the secondary outcome, the results were also organised in a prediction matrix and expressed as probabilities.

Results

For 71 patients treated with TDR according to protocol, the follow-up time was 8 years. For a subgroup of 11 patients randomised to rehabilitation who crossed over and received TDR, the median postoperative follow-up time was 72 (range 41–88) months. Of all assessed baseline variables, only presence of Modic changes (type 1 and/or 2) was statistically significantly associated with an improvement of ≥ 15 ODI points. The probability of employment at 8-year follow-up was 1% for patients with ≥ 1 year of sick leave, comorbidity, ODI ≥ 50 and ≤ 9 years of education prior to treatment, and 87% for patients with < 1 year of sick leave, no comorbidity, ODI < 50 and higher education.

Conclusions

Patients with Modic changes prior to the TDR surgery were more likely to report a clinically important functional improvement at long-term follow-up. Comorbidity, low level of education, long-term sick leave and high ODI score at baseline were associated with unemployment at long-term follow-up.

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Acknowledgements

Maren Hjelle Guddal: collecting and punching data. Marianne Bakke Johnsen: collecting and punching data. Eira Kathleen Ebbs: language help.

Author information

Authors and Affiliations

  1. Department of Surgery, Innlandet Hospital Gjøvik, Kyrre Grepps Gate 11, 2819, Gjøvik, Norway

    Håvard Furunes

  2. University of Oslo, Blindern, Postbox 1072, 0316, Oslo, Norway

    Håvard Furunes, Jens Ivar Brox & Kjersti Storheim

  3. Oslo University Hospital Ullevål, FORMI, Building 37B, Nydalen, Postbox 4950, 0424, Oslo, Norway

    Håvard Furunes, Milada Cvancarova Småstuen & Kjersti Storheim

  4. Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway

    Christian Hellum

  5. Department for Physical Medicine and Rehabilitation, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway

    Jens Ivar Brox

  6. Department of Orthopaedic Surgery, St Olav’s University Hospital, Prinsesse Kristinas Gate 3, 7030, Trondheim, Norway

    Ivar Rossvoll

  7. Department of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Høgskoleringen 1, 7491, Trondheim, Norway

    Ivar Rossvoll

  8. Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway

    Ansgar Espeland

  9. Department of Clinical Medicine, University of Bergen, PB 7804, 5020, Bergen, Norway

    Ansgar Espeland

  10. Department of Radiology, Nordland Hospital, Postbox 1480, 8092, Bodø, Norway

    Linda Berg

  11. Institute of Clinical Medicine, UiT, The Arctic University of Norway, Langnes, Postbox 6050, 9037, Tromsø, Norway

    Linda Berg

  12. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway

    Helga Maria Brøgger

  13. Department of Health Science, Oslo and Akershus University College of Applied Sciences, St. Olavs Plass, PO Box 4, 0130, Oslo, Norway

    Milada Cvancarova Småstuen

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  1. Håvard Furunes
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  4. Ivar Rossvoll
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Corresponding author

Correspondence to Håvard Furunes.

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Conflict of interest

None of the authors has any potential conflict of interest.

Funding

The study was funded by Oslo University Hospital, South Eastern Norway Regional Health Authority (Grant no. 2007082) and EXTRA funds from the Norwegian Foundation for Health and Rehabilitation through the Norwegian Back Pain Association ((Grant no. 2012/2/0236). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.

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Furunes, H., Hellum, C., Brox, J.I. et al. Lumbar total disc replacement: predictors for long-term outcome. Eur Spine J 27, 709–718 (2018). https://doi.org/10.1007/s00586-017-5375-1

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  • DOI: https://doi.org/10.1007/s00586-017-5375-1

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