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. 2022 Jul 25;16(5):837-846.
doi: 10.14444/8330. Online ahead of print.

Single-Level Total Disc Replacement: Mid- to Long-Term Outcomes

Matthew Scott-Young  1   2 , Laurence McEntee  2   3 , Evelyne Rathbone  2 , David Nielsen  4   5 , Lauren Grierson  4 , Wayne Hing  2
Affiliations

Single-Level Total Disc Replacement: Mid- to Long-Term Outcomes

Matthew Scott-Young et al. Int J Spine Surg. .

Abstract

Background: Total disc replacement (TDR) has been shown to be effective for the treatment of lumbar degenerative disc disease (DDD) in carefully selected patients. Previous studies have demonstrated high rates of patient satisfaction and improvement in patient-reported outcome measures (PROMs) compared with preoperative status but most have short-term follow-up or small cohort sizes only.

Objective: The aim of this study is to report mid- to long-term PROMs from the treatment of symptomatic single-level lumbar DDD with TDR.

Methods: Data collected prospectively concerning single-level TDR performed via an anterior approach were included for analysis. A preoperative assessment was obtained followed by postoperative follow-up assessments at 3, 6, and 12 months, and yearly follow-up thereafter. PROMs included patient satisfaction, visual analog score back and leg, Oswestry Disability Index, and Roland-Morris Disability Questionnaire.

Results: A total of 211 patients (118 men, 93 women) operated on between June 1997 and July 2015 were included in this study. Minimum follow-up was 4 years. The average age was 42.2 (range 24-87) years and median follow-up 96 interquartile range 72-132, range 48-120) months. The operative levels were L5-S1 (160, 75.8%) and L4-L5 (61, 24.2%). Both statistically and clinically significant improvements observed postoperatively were maintained at 10 years. In addition, 92% of patients reported either good (n = 29) or excellent satisfaction (n = 155) with treatment at final review.

Conclusions: This study shows that single-level lumbar TDR used appropriately in selected patient results in clinically significant improvements in pain and function, well above the minimum clinically important difference, and good to excellent satisfaction in most patients. Further study to define long-term outcomes and survivorship is required.

Clinical relevance: Statistically significant and clinically relevant improvements can be achieved by single-level lumbar TDR, in the treatment of single-level discogenic axial low back pain, with or without radiculopathy. These outcomes are sustained in the mid- to long-term followup periods.

Keywords: back pain; degenerative disc disease; long-term outcomes; lumbar spine; motion preservation; single level; total disc arthroplasty; total disc replacement.

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Conflict of interest statement

Declaration of Conflicting Interests: Matthew Scott-Young previously received royalties and had a consulting agreement with DePuy Synthes Spine. The remaining authors have no disclosures.

Figures

Figure 1
Figure 1
Profile of the mean reduction from baseline and 95% CIs for visual analog scale (VAS) back and leg pain scores. All improvements from baseline were statistically significant (P < 0.001).
Figure 2
Figure 2
Profile of the mean reduction from baseline and 95% CIs for Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ) disability scores. All improvements from baseline were statistically significant (P < 0.001).
Figure 3
Figure 3
X-ray images of a Charité Artificial Disc at 183 mo after surgery: (a) flexion, (b) extension, (c) anteroposterior, and (d) lateral.
Figure 4
Figure 4
Patient satisfaction levels over the duration of postsurgery follow-up (N = 211).
See this image and copyright information in PMC

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