The Journal of Bone and Joint Surgery (American). 2005;87:490-496.
doi:10.2106/JBJS.C.01345
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Lumbar Total Disc Replacement

Seven to Eleven-Year Follow-Up

Patrick Tropiano, MD1, Russel C. Huang, MD2, Federico P. Girardi, MD2, Frank P. Cammisa, Jr., MD2 and Thierry Marnay, MD3

1 Department of Orthopaedic Surgery, Hôpital CHU Nord, Chemin des Bourrelly, 13915 Marseille CEDEX 20, France
2 The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for R.C. Huang: russelhuang{at}yahoo.com
3 Department of Orthopaedic Surgery, Clinique du Parc, 50 Rue Emile-Combes, Boite Postal 20, 34171 Castelnau-le-Lez, France

Investigation performed at the Department of Orthopaedic Surgery, Clinique du Parc, Castelnau-le-Lez, France

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Spine Solutions. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Spine Solutions). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Symptomatic lumbar degenerative disc disease is a challenging entity to treat. The results of arthrodesis may be compromised in the short term by pseudarthrosis and in the long term by pain at the iliac-crest donor site and by junctional degeneration. Total disc replacement has the potential to provide long-lasting relief to these patients. The purpose of this study was to present the clinical and radiographic results assessed seven to eleven years following a Prodisc total lumbar disc replacement.

Methods: Sixty-four patients had single or multiple-level implantation of a total lumbar disc replacement between 1990 and 1993. The mean duration of follow-up was 8.7 years. Clinical results were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and postoperative radiographs were evaluated as well. Subgroup analysis was performed to determine if gender, an age of less than forty-five years, previous surgery, or multilevel surgery had an effect on outcome.

Results: At an average of 8.7 years postoperatively, there were significant improvements in the back-pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Thirty-three of the fifty-five patients with sufficient follow-up had an excellent result, eight had a good result, and fourteen had a poor result. Neither gender nor multilevel surgery affected outcome. An age of less than forty-five years and prior lumbar surgery had small but significant negative effects on outcome. Radiographs did not demonstrate loosening, migration, or mechanical failure in any patient. Five patients had approach-related complications.

Conclusions: The Prodisc lumbar total disc replacement appears to be effective and safe for the treatment of symptomatic degenerative disc disease. Gender and multilevel surgery did not affect the outcomes, whereas prior lumbar surgery or an age of less than forty-five years was associated with slightly worse outcomes. Longer follow-up of this cohort of patients and randomized trials comparing disc replacement with arthrodesis are needed.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Lumbar Total Disc Replacement
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Letters to the Editor:

Read all Letters to the Editor

Lumbar Total Disc Replacement
Bipin Theruvil, FRCS, et al.
JBJS Online, 20 Apr 2005 [Full text]
Dr Huang and Colleagues respond to Dr. Theruvil, et al
Russel C. Huang, et al.
JBJS Online, 21 Apr 2005 [Full text]