Segmental Contribution Toward Total Lumbar Range of Motion in Disc Replacement and Fusions: A Comparison of Operative and Adjacent Levels

Radiographic results from a prospective, randomized, multicenter trial assessing patients who underwent lumbar total disc replacement (TDR) or circumferential arthrodesis for 1-level degenerative disc disease. To quantify the relative segmental contribution to total lumbar range of motion (ROM) at t...

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Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2009-11, Vol.34 (23), p.2510-2517
Main Authors: AUERBACH, Joshua D, JONES, Kristofer J, MILBY, Andrew H, ANAKWENZE, Okechukwu A, BALDERSTON, Richard A
Format: Article
Language:English
Subjects:
Adult
Analysis of Variance
Arthroplasty, Replacement - methods
Biological and medical sciences
Cerebrospinal fluid. Meninges. Spinal cord
Female
Humans
Intervertebral Disc - diagnostic imaging
Intervertebral Disc - surgery
Intervertebral Disc Degeneration - diagnostic imaging
Intervertebral Disc Degeneration - surgery
Joint Prosthesis
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - surgery
Male
Medical sciences
Middle Aged
Nervous system (semeiology, syndromes)
Neurology
Orthopedic surgery
Patient Satisfaction
Patient Selection
Prospective Studies
Prosthesis Implantation
Radiography
Range of Motion, Articular - physiology
Spinal Fusion - methods
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Treatment Outcome
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Summary:Radiographic results from a prospective, randomized, multicenter trial assessing patients who underwent lumbar total disc replacement (TDR) or circumferential arthrodesis for 1-level degenerative disc disease. To quantify the relative segmental contribution to total lumbar range of motion (ROM) at the operative level at each adjacent level in lumbar TDR and arthrodesis. Although previous studies have evaluated ROM in TDR and fusion, no study has quantified or compared the relative segmental contribution to total lumbar ROM. Further, no study to the best of our knowledge has evaluated the kinematic profile of the more cranial adjacent segments (i.e., the second or third adjacent levels) following implantation of either TDR or fusion. Radiographic data collected from all randomized 1-level degenerative disc disease patients operated at L4/5 or L5/S1 that participated in the multicenter, prospective, randomized IDE study comparing ProDisc-L with circumferential lumbar arthrodesis were evaluated before surgery and at 24 months. Radiographic measurements were performed independently using custom digitized image stabilization software to generate ROM at the operative level, and at each cranial and caudal adjacent level. There were 200 total patients included (155 ProDisc-L, average age 39 years; 45 arthrodesis, average age 40 years). At 24 months, the L4/5 TDR group experienced a significant improvement in total lumbar ROM from baseline (+6.3 degrees ), whereas there was no change seen with L5/S1 TDR or any fusion group. Between-group comparisons from baseline to 24 months postoperatively revealed: (1) significantly more contribution from the operative level towards total lumbar range in TDR at operative level L4/5 (TDR: -2.5%, fusion: -16.8%, P = 0.006), and operative level L5/S1 (TDR: -5.1%, fusion: -15.9%, P < 0.001), and (2) the relative contribution towards total lumbar range of motion from the first cranial adjacent segment to fusion at L5/S1 increased by 12.1%, compared with -1.2% seen in TDR (P = 0.03). There were elevated contributions from the more cranial adjacent levels to a fusion when compared with TDR, however, these differences were not statistically significant. At operative level L4/5, there was significantly increased ROM from the first caudal segment below TDR (6%, P = 0.03), but not below fusion (3.1%, P = 0.59). In conclusion, patients with TDR lost slight relative contribution to total lumbar motion from the operative level which was mostl
ISSN:0362-2436
1528-1159
DOI:10.1097/BRS.0b013e3181af2622