Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: 8-year follow-up of a randomized controlled multicenter trial

Abstract

Substantial long-term improvement can be expected after both disc replacement and MDR. The difference between groups is statistically significant in favor of surgery, but smaller than the prespecified clinically important difference of 10 ODI points that the study was designed to detect. Future research should aim to improve selection criteria for disc replacement and MDR.

Lumbar total disc replacement: predictors for long-term outcome

“…The categorisation was based on the presence or absence of suggested contraindications for TDR (surgery at the adjacent level of a fused segment, spondylolisthesis, facet joint arthritis and lateral recess stenosis). In the randomised trial from which our data are extracted, 24 % of the patients had no symptoms of back pain eight years after TDR, and yet 8 % described themselves as "worse than ever" [10]. This illustrates the obvious need for improved patient selection criteria for disc replacement.…”

Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Nonoperative Treatment

“…Regardless of allocation, 91 patients in our cohort have been treated with TDR [8], of whom one (1%) has been re-operated with fusion including the adjacent segment. This is in agreement with other studies reporting re-operation due to ADD in 0-1% of patients after two to five years following TDR [27][28][29].…”

“…However, the analyzed treatment groups had similar pre-treatment clinical, demographical and radiological characteristics. Since 24% of the patients randomized to rehabilitation were treated surgically, and 10% of those randomized to TDR were not operated [8], we considered an intention-totreat analysis to be unsuitable for analyzing the influence of TDR on ADD.…”

“…This is a randomized multicenter study with eight-year follow-up conducted at five university hospitals in Norway [8]. The eight-year follow-up was approved by the Norwegian Regional Ethical Committee South East C (2011/2177).…”

Künstliche Bandscheibe in der Lendenwirbelsäule – Hype oder Hope?

“…24 % der Patienten in der konservativen Gruppe wechselten im Verlauf in die Prothesengruppe. 14 % der operierten Patienten erhielten weitere lumbale Eingriffe bei nur einer Majorkomplikation [51]. In einer Subgruppenanalyse der operierten Patienten fanden die Autoren heraus, dass nur Modic-I-oder Modic-II-Veränderungen signifikant mit einer Verbesserung des ODI von ≥ 15 Punkten korrelierten [52].…”