Charité total disc replacement—clinical and radiographical results after an average follow-up of 17 years

Putzier, Michael; Funk, Julia F.; Schneider, Sascha; Groß, Christian; Tohtz, Stephan; Khodadadyan-Klostermann, Cyrus; Perka, Carsten; Kandziora, Frank

doi:10.1007/s00586-005-1022-3

Cited by 194 publications

(131 citation statements)

References 45 publications

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“…3b). Comparable bridging was described in previous studies after implantation of lumbar disc prosthesis [31]. Maybe, this observation is attributable to the hematoma resulting from preparation of the endplates which serves as a primary callus in a bone defect.…”

Section: Discussionsupporting

confidence: 57%

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

et al. 2009

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Section: Discussionsupporting

confidence: 57%

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

et al. 2009

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“…After a minimum 11-year follow-up, one revision surgery was performed at the upper adjacent level because of adjacent segment degeneration. However, compared with other long-term studies [28][29][30][31][32][33], we found a more favorable survival rate. There are several possible reasons for this which may be summarized as follows: one is our strict indication for TDR since we can never be too cautious; another important reason may be that most Chinese are much lighter in weight compared to the western population, which may affect the survival rate of the prosthesis since a much smaller continuous load is exerted on the prosthesis; the third reason could be that the surgeon is very familiar with the anterior retroperitoneal approach which helped to reduce and to deal with severe complications.…”

Section: Discussioncontrasting

confidence: 75%

An 11-year minimum follow-up of the Charite III lumbar disc replacement for the treatment of symptomatic degenerative disc disease

Hai

Kong

et al. 2015

Eur Spine J

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Purpose To report our 11-year minimum clinical and radiological outcomes, as well as complications of the Charite III total disc replacement (TDR). Methods A total of 35 patients indicated for total disc replacement were implanted with the Charite III prosthesis. Clinical evaluation included visual analog scale (VAS) for back pain and the Oswestry disability index (ODI). Radiological parameters of intervertebral disc height (IDH), range of motion (ROM), lumbar lordosis, lumbar scoliosis and prosthesis position were evaluated. Complications and reoperation rates were also assessed. Results Thirty-two patients had a minimum 11-year follow-up, and 33 prostheses were implanted. The mean follow-up time was 11.8 years, ranging from 11.3 to 13.8 years. Twenty-eight patients (87.5 %) had a successful outcome, as defined by the FDA. Reoperation was performed in 2 patients for adjacent segment degeneration and pedicle fracture (1 case each). Both VAS and ODI scores showed significant improvement compared to baseline. At the final follow-up, the ROM of both the index-and adjacent-level showed an obvious decrease. The IDH of the index level showed a tendency to decrease, but the difference was not significant. The IDH of adjacent levels were not significantly affected by the surgery. Mean lumbar lordosis was increased at the final follow-up, and lumbar scoliosis over 3°was observed in 12 patients (37.5 %), with a mean angle of 5.6°(range 3°-12°). Of all 35 prostheses, 15 were left-shifted, 3 were right-shifted and 14 were just in the middle. In the coronal plane, 25 were rated as ideally placed, 5 were discretely shifted, 4 were slightly shifted and 1 was markedly shifted. In the sagittal plane, only 12 prostheses were rated as ideally placed, 14 were discretely shifted and 9 were suboptimally placed. Prosthesis subsidence was noted in 3 (9.4 %) patients (the subsidence distances were 3.1, 4.2 and 2.8 mm, respectively). Heterotopic ossification was detected in 25 segments (71.4 %), consisting of Class-I heterotopic ossification in 7 segments (20.0 %), Class-II in 9 segments (25.7 %), and Class-III in 9 segments (25.7 %). Class-IV heterotopic ossification was not observed. Conclusion The cumulative survival was 100 % at a mean follow-up of 11.8 years. Clinical and radiological results were satisfactory and long-term clinical results were maintained for a mean follow-up of 11.8 years. Reoperation and complication rates are acceptable, and our study does not substantiate the fear of reoperation or late complications. The results of our long-term follow-up indicate that, with strict indication, TDR is a safe and effective procedure as an alternative to lumbar fusion.

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“…According to the authors, this high incidence of facet degeneration after an average FU of only 38-41 months seemed to be too short to be explained by the natural course of degeneration. Other study group's findings have similarly tempered the initial enthusiasm [51,52,64]. An increasing number of radiographic and biomechanical studies are suggesting that TDR interferes with the highly sensitive biomechanics of the spine.…”

Section: Discussionmentioning

confidence: 98%

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (C29) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P \ 0.05). Patients with an early onset of pain (B6 months) were 2-59 higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P \ 0.05). The level of TDR significantly influenced postoperative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJpain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failureanalysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.

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Charité total disc replacement—clinical and radiographical results after an average follow-up of 17 years

Cited by 194 publications

References 45 publications

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

An 11-year minimum follow-up of the Charite III lumbar disc replacement for the treatment of symptomatic degenerative disc disease

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

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