Background: Lumbar total disc replacement (TDR) is an alternative to lumbar fusion for the management of degenerative disc disease. This study aims to provide insight into the long-term clinical outcomes of lumbar TDR with a mean follow-up of 17.2 years in a group of workers' compensation patients.Methods: A total of 26 workers' compensation patients with radiographically confirmed discogenic low back pain were treated with the Charité total lumbar disc replacement. Visual analog scale (VAS) scores were assessed before and after the surgery. At follow-up, patients were assessed on quality of life, employment, further lumbar spine surgeries, and associated complications. Simple nonparametric statistical analysis was performed by the first author using Microsoft Excel.Results: Sixteen patients (62%) were able to be contacted with a mean follow-up time of 17.2 years. VAS scores at 17 years were significantly lower than their preoperation level. Of those 16 patients, 81% returned to work and worked for an average of 9.1 years after surgery. Additionally, 6 (38%) patients underwent further lumbar spinal surgery, of whom 4 underwent fusions of the adjacent segment. Nearly all patients (94%) were satisfied with the surgery.Conclusion: This study suggests lumbar TDR may be a useful treatment for degenerative disc disease in select workers' compensation patients.Clinical Relevance: Clinically relevant improvements in pain and employment can be achieved with the charite lumbar TDR in the treatment of degenerative disc disease in workers' compensation patients. These results are sustained over the long term.

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented social and economic disruption, accompanied by the enactment of a multitude of public health measures to restrain disease transmission. These public health and social measures have had a considerable impact on lifestyle and mental wellbeing, which has been well-studied in metropolitan populations, but very little in rural populations. Additionally, the development and use of a standardised scoring system for an overall assessment of patient lifestyle management, and monitoring of changes in these, may be warranted in clinical practice.MethodsThe associations between psychological distress and changes in SNAPS health behaviours (smoking, nutrition, alcohol, physical activity, sleep) since the onset of COVID-19 in rural Australia were examined. A cross-sectional anonymous online survey was distributed among adults in the Western New South Wales Primary Health Network in August 2020. The survey included measures of psychological distress, income, disposition, lifestyle factors and behaviours during the pandemic, as well as changes in lifestyle due to COVID-19. A novel Global Lifestyle Score (GLS) was generated as a holistic assessment of lifestyle across multiple domains.ResultsThe survey was completed by 308 individuals (modal age group: 45-54 years old, 86.4% female). High distress on the K5 scale was present in over one-third of respondents (n=98, 34.3%). Negative change was reported for sleep (24.4%), nutrition (14.3%), alcohol (17.8%), physical exercise (33.8%) and smoking (26.6%) since the onset of the pandemic. Additionally, changes in sleep, nutrition, physical activity and smoking were associated with distress. Respondents with a poor lifestyle (GLS) during the pandemic were significantly more distressed. Perceived COVID-19 impact was associated with high distress, level of drought impact and loss of income.ConclusionHigh rates of distress amongst rural Australians during the COVID-19 pandemic was linked, worsening lifestyles as measured by the GLS and loss of income. Lifestyle promotion strategies should be considered by health professionals for the management of crisis-related distress. Further research may explore the impact of COVID-19 on a larger population, including a greater proportion of male respondents, and the impact of modifying lifestyle factors on the reduction of distress in the context of a stressor such as this pandemic.