Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Nonoperative Treatment

Furunes, Håvard; Hellum, Christian; Espeland, Ansgar; Brox, Jens Ivar; Småstuen, Milada Cvancarova; Berg, Linda; Storheim, Kjersti

doi:10.1097/brs.0000000000002712

Cited by 15 publications

(7 citation statements)

References 36 publications

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“…4, [15][16][17][18][19][20][21][22] A recent study showed no significant difference in adjacent segment degeneration rates at 8 years between patients who underwent lumbar TDR (42%) and those who continued with nonsurgical treatment (40%). 23 These data suggest that the progression of adjacent segment degeneration is part of the natural history of DDD but may be accelerated by lumbar fusion. Consistent with clinical evidence, biomechanical data demonstrate that the loss of motion caused by spinal fusion transfers stresses to adjacent spinal regions and causes accelerated degeneration.…”

Section: Introductionmentioning

confidence: 86%

Final Long-Term Reporting from a Randomized Controlled IDE Trial for Lumbar Artificial Discs in Single-Level Degenerative Disc Disease: 7-Year Results

Radcliff

Zigler

Braxton³

et al. 2021

Int J Spine Surg

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Background: This study compared 7-year safety and efficacy outcomes of activL and ProDisc-L lumbar total disc replacements in patients with symptomatic, single-level lumbar degenerative disc disease (DDD). The objectives are to report 7-year outcomes of the trial, evaluate the outcomes for patients lost to follow-up, and determine whether early outcomes predict long-term outcomes.Methods: This was a prospective, multicenter, randomized, controlled investigational device exemption study. Eligible patients with symptomatic, single-level lumbar DDD had failed !6 months of nonsurgical management. Patients (N ¼ 283) were randomized to receive activL (n ¼ 218) or ProDisc-L (n ¼ 65). At 7 years, data were available from 206 patients (activL, 160; 46). Logistic regression models were fit to predict 7-year outcomes for patients lost to follow-up after 2 years.Results: At 7 years, the activL group was noninferior to the ProDisc-L group on the primary composite endpoint (P ¼ .0369). Both groups showed significant reductions in back/leg pain severity and improvements in disability index and quality-of-life relative to baseline (P , .0001). In both groups, opioid use was significantly reduced at 7 years (0%) relative to baseline (P , .01), and the overall reoperation rates were low (4.6%). activL patients showed a significantly better range of motion (ROM) for flexion-extension rotation than ProDisc-L patients (P ¼ .0334). A significantly higher proportion of activL patients did not report serious adverse events (activL, 62%; ProDisc-L, 43%; P ¼ .011). Predictive modeling indicated that .70% of patients (depending on outcome) lost to follow-up after 2 years would show clinically significant improvement at 7 years if improvements were achieved at 2 years.Conclusions: The benefits of activL and ProDisc-L are maintained after 7 years, with significant improvements from baseline observed in pain, function, and opioid use. activL is more effective at preserving ROM than ProDisc-L and has a more favorable safety profile. Improvements in other primary and secondary outcomes were similar between both disc designs.Level of Evidence: 1.

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Section: Introductionmentioning

confidence: 86%

Final Long-Term Reporting from a Randomized Controlled IDE Trial for Lumbar Artificial Discs in Single-Level Degenerative Disc Disease: 7-Year Results

Radcliff

Zigler

Braxton³

et al. 2021

Int J Spine Surg

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“…A meta-analysis 13 that evaluated surgery with simple discectomy and discectomy with bone-anchored device versus continued conservative treatment, presented evidence that surgery is more effective for symptom relief than persisting with continued conservative treatment in cases where the patient is refractory to initial conservative treatment 13 . The evaluation of the success or failure of disc protrusion treatment by the quantitative sensory test (QST), which uses different stimuli to evaluate the perception of temperature and pain, found no differences in all parameters evaluated at the 3 to6 months follow-ups in patients treated conservatively with steroid injections or with surgical treatment 14 . One of the studies compared total disc replacement surgery in 69 patients.…”

Section: Resultsmentioning

confidence: 99%

“…NSAIDs = nonsteroidal anti-inflammatory drugs. The studies 5,[6][7][8][9]11,13,14,17,20 report that conservative management is most beneficial to patients, while studies 10,11,12,15 report that surgical management is most beneficial to patients.…”

Section: Not Specifiedmentioning

confidence: 99%

Conservative versus surgical treatment in patients with lumbar disc herniation

Filho¹,

Gonçalves²,

Barbosa³

2021

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: Herniated disc is a common pathology, affecting about 5 to 10 cases per 1000 adults annually. A conservative or a surgical approach to treatment can be adopted. The present study's objective was to evaluate each of these approaches. CONTENTS: An integrative literature review was carried out, aiming to understand which treatment provides greater benefits in the short, medium, and long term for patients with low back disc herniation. Of the 4941 articles found, 4852 were excluded by title, 75 by abstract and 14 were selected for the study. Of these 14 studies, 10 considered the conservative approach more beneficial to patients, while 4 considered the surgical conduct more beneficial. CONCLUSION: Surgical treatment is a good option for those cases in which patients have debilitating pain and need rapid pain relief. However, in the long run, there is no superiority of surgery over conservative treatment.

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“…The randomized controlled trial of Furunes et al . 52 demonstrated that there was no significant difference in the increase in the rate of adjacent segment degeneration after TDA compared with the non‐operative group, indicating that TDA does not increase the risk of adjacent segment degeneration. Berg et al .…”

Section: Surgical Treatmentmentioning

confidence: 90%

“…Although both operations had satisfactory results for pain relief, TDA showed a better trend at 5-year follow-up. The randomized controlled trial of Furunes et al 52 demonstrated that there was no significant difference in the increase in the rate of adjacent segment degeneration after TDA compared with the non-operative group, indicating that TDA does not increase the risk of adjacent segment degeneration. Berg et al 53 used distortion-compensated Roentgen analysis to evaluate the difference between TDA and intervertebral disc fusion.…”

Section: Total Disc Replacementmentioning

confidence: 99%

Treatment of Intervertebral Disc Degeneration

Xin

Wang

Zheng

et al. 2022

Orthopaedic Surgery

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Intervertebral disc degeneration (IDD) causes a variety of signs and symptoms, such as low back pain (LBP), intervertebral disc herniation, and spinal stenosis, which contribute to high social and economic costs. IDD results from many factors, including genetic factors, aging, mechanical injury, malnutrition, and so on. The pathological changes of IDD are mainly composed of the senescence and apoptosis of nucleus pulposus cells (NPCs), the progressive degeneration of extracellular matrix (ECM), the fibrosis of annulus fibrosus (AF), and the inflammatory response. At present, IDD can be treated by conservative treatment and surgical treatment based on patients' symptoms. However, all of these can only release the pain but cannot reverse IDD and reconstruct the mechanical function of the spine. The latest research is moving towards the field of biotherapy. Mesenchymal stem cells (MSCs) are regard as the potential therapy of IDD because of their ability to self-renew and differentiate into a variety of tissues. Moreover, the non-coding RNAs (ncRNAs) are found to regulate many vital processes in IDD. There have been many successes in the in vitro and animal studies of using biotherapy to treat IDD, but how to transform the experimental data to real therapy which can apply to humans is still a challenge. This article mainly reviews the treatment strategies and research progress of IDD and indicates that there are many problems that need to be solved if the new biotherapy is to be applied to clinical treatment of IDD. This will provide reference and guidance for clinical treatment and research direction of IDD.

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Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Nonoperative Treatment

Abstract: 1.

Cited by 15 publications

References 36 publications

Final Long-Term Reporting from a Randomized Controlled IDE Trial for Lumbar Artificial Discs in Single-Level Degenerative Disc Disease: 7-Year Results

Final Long-Term Reporting from a Randomized Controlled IDE Trial for Lumbar Artificial Discs in Single-Level Degenerative Disc Disease: 7-Year Results

Conservative versus surgical treatment in patients with lumbar disc herniation

Treatment of Intervertebral Disc Degeneration

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