Interdependence Between Disc Space Height, Range of Motion and Clinical Outcome in Total Lumbar Disc Replacement

Abstract

A significant interdependence was observed between the parameters DSH, ROM and the clinical outcome following TDR. Whilst the DSH is restored, TDR leads to a significant decrease in postoperative ROM, particularly at the lumbosacral junction. Higher preoperative DSH and ROM revealed a beneficial effect on the postoperative segmental mobility. The subjective outcome evaluation indicates that TDR is a viable treatment option even in advanced stages of degenerative disc disease in the absence of other contraindications, in particular facet joint arthropathies.

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

“…Due to the small number of patients, the results (especially the non-significant results) should be interpreted with caution. However, the radiologic factors that we found to be associated with inferior outcomes after TDR are supported by the calculations of our probabilistic FEM study and are consistent with several clinical observational studies [20,[25][26][27]. Additionally, significant results were obtained despite the use of relatively rigid statistical methods.…”

“…Distraction is usually necessary because the restoration of disc height after TDR is an important factor for a good clinical outcome [26,40]. However, it is difficult for the surgeon to determine the ideal degree of correction of a degenerated disc, because the optimum amount is unknown and varies individually.…”

“…Interestingly, patients with FJD progression after TDR present with inferior clinical results a few month postoperatively [23], which suggests that FJD itself may not be the only cause of pain or functional impairment. Several factors, such as malposition in the frontal plane, the grade of restoration of the disc height by segmental distraction, or the consecutive changes of the local sagittal curve with increased segmental lordosis, may affect facet joint forces after TDR [20,25,26]. In our probabilistic finite element model (FEM) analysis [27], we demonstrated that a segmental misalignment in the sagittal plane after TDR with an anterior or posterior shift of the superior vertebra leads to a significant increase in facet joint contact or capsule tensile forces.…”

Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up

“…Zindrick et al [10] concluded in a review that there was no definitive evidence about which variables that affect outcome in disc prosthesis surgery. Siepe et al [28,29], reported better outcomes for disc surgery in younger patients, for monosegmental surgery (especially at the L4/L5 level) and in patients with lower disc height. Bertagnoli et al found better outcomes in patients with disc height [4 mm and no facet joint arthritis, and Guyer et al found that time off work before treatment predicted outcome [30,31].…”

Effects of Exercise Rehabilitation on Pain, Disability, and Muscle Strength after Posterior Lumbar Interbody Fusion Surgery: a Randomized Controlled Trial

“…Ten seconds of rest were allowed between each angle, and a passive ROM exercise was conducted 3 times to relax the lumbar extensor. The reliability of this method is r = 0.81-0.89 19) .…”