Professional paper
Low-back pain and total disk replacement (TDR) in lumbar spine
Vladimir KOVAČ
; Odjel za ortopediju, Klinička bolnica¨Dubrava¨ Zagreb
Dubravka SRDOČ
; Zavod za radiologiju Klinička bolnica¨Dubrava¨ Zagreb
Abstract
Despite excellent early results of spinal fusion in chronic backache treatment, long term results indicate problematic (30-50%) incidence of very good results. The aim of the study is to present results of total disc arthoplasty as an alternative to spinal fusion.
“Maverick” implant was inserted in 7 patients in the period January-October 2003. “Flexicore” implants were applied in 13 patients in the period October 2006-January 2008. Patients were 28-50 yr old; procedure was performed through conventional trans or retroperitoneal approach. Indications were: Degenerative spondylolisthesis, primary instability, painful DDD. Most frequent indication was failed back syndrome. All the patients had multilevel degenerative changes and were not good candidates for fusion. Criteria were backache at least 1 yr of continuous pain. Average hospitalization 5 days.
“Maverick” group (No=8): Early results: At L4-5 level there was no back or leg pain, while after all the L5-S1 surgeries remained more or less significant back and/or leg pain. Because of instrumentation failure there was one intrusion of bone fragments in spinal canal. In two patients the pain was relieved 1 yr post op. A metastatic cancer appeared in one patient 1,5 yr post op.
“Flexicore” group (N=13): In all the cases there was a complete pain relief (7 failed backs, 1 deg. Spondylolisthesis, 1 hemisacralisation, 4 primary instabilities). In two cases additional posterior decompression was necessary because of remained disc fragments in spinal canal.
It seems that TDR is efficient method in moderate disc instability, and in failed back syndrome. It is possible to mobilize osteochondrotic immobile disc and to unload the adjacent degenerative segments. The rehabilitation is shorter comparing to fusion. Complications can be related to “learning curve”. It “Flexicore” implantation is less demanding procedure, with less operative risk. Suboptimal implant insertion probably does not interfere with early results. Learning curve is critical for optimal results. All TDR patients had shorter rehabilitation and better clinical outcome comparing to published fusion outcomes. It seems TDR is a procedure of choice comparing to other non-fusion techniques and fusion procedures.
Keywords
Low back pain; operative treatment; artificial disc
Hrčak ID:
135258
URI
Publication date:
13.6.2011.
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