Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up

Siepe, Christoph J.; Heider, Franziska; Wiechert, Karsten; Hitzl, Wolfgang; Ishak, Basem; Mayer, Michael H.

doi:10.1016/j.spinee.2013.08.028

Cited by 99 publications

(94 citation statements)

References 133 publications

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“…Reoperations at the index level are required in 0-28.6 % of cases [31,[43][44][45]. Siepe et al [45] categorized the reoperation rates into those resulting from general surgeryrelated complications, those for implant-or device-related complications, and those that were required for the treatment of adjacent-level pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…Siepe et al [45] categorized the reoperation rates into those resulting from general surgeryrelated complications, those for implant-or device-related complications, and those that were required for the treatment of adjacent-level pathologies. In this study, they found that the majority of revision surgeries were performed for persistent back pain, and that fewer were performed for implant failures.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…The reasons for this trend might include historical shortcomings, biomechanical concerns regarding wear debris and device failure, strict indications for use, and challenging surgical techniques with a long learning curve. Also, the fear of late complications, revision surgeries, conflicting data from published meta-analysis, lack of TDR selection, and reimbursement issues are other plausible reasons [31][32][33].…”

Section: Successes and Obstacles To Widespread Adoptionmentioning

confidence: 99%

“…Single-level TDRs demonstrated lower complications (11.9 vs 27.6%; p = 0.03) and greater satisfaction rates compared to two-level cases. In consideration of their reported acceptable complication and reoperation rates, the authors concluded that fear of excessive late complications following ProDisc II implantation are not justified [32].…”

Section: Prodisc Lumbar Disc Replacementmentioning

confidence: 99%

Lumbar disc replacement surgery—successes and obstacles to widespread adoption

Salzmann

Plais

Shue

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of review Lumbar disc replacement has been a surgical alternative to fusion surgery for the treatment of lumbar degenerative disc disease (DDD) for many years. Despite enthusiasm after the approval of the first devices, implantation rates have remained low, especially in the USA. The goal of this review is to provide a general overview of lumbar disc replacement in order to comprehend the successes and obstacles to widespread adoption. Recent findings Although a large amount of evidence-based data including satisfactory long-term results is available, implantation rates in the USA have not increased in the last decade. Possible explanations for this include strict indications for use, challenging surgical techniques, lack of device selection, fear of late complications or revision surgeries, and reimbursement issues. Summary Recent publications can address some of the past concerns, but there still remain obstacles to widespread adoption. Upcoming data on long-term outcome, implant durability and possible very late complications will determine the future of lumbar disc replacement surgery.

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“…Spinal fusion has been the gold standard until the advent of motion sparing technologies, i.e., the total disc arthroplasty, which were first introduced in the mid 1980s [1][2][3][4]. Clinical fusion studies indicate that standard lordotic interbody cages seldom improve the patient's sagittal balance, but generally, they improve the disc height and fusion rate [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Two-piece ALIF cage optimizes the bone–implant interface in a 360° setting

Wilke

Volkheimer

Robie³

et al. 2017

Eur Spine J

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Introduction Clinical research has documented that cage subsidence and the loss of balance correction is a significant complication related to spinal fusion. Subsidence is a multifactorial complication, where implant design is one important element. The aim of the study is to compare the rigidity and bone-implant relative motion of segments treated with either a conventional one-piece ALIF cage versus a two-piece ALIF cage, which adapts in situ and permits 7°-21°of lordosis. Methods Seven lumbosacral (L3-S1) human cadaver specimens were tested in a universal spine tester in the intact condition, the specimens instrumented with a twopiece ALIF cage (Statur Ò -L, FBC Device, Denmark) and a one-piece ALIF cage (Pezo TM -A, Ulrich GmbH & Co. KG., Germany), both supplemented with a pedicle screw system using pure moments of ±7.5 Nm in three principal motion directions. For assessment of the bone-implant interface, fluoroscopic videos were captured during motion and 3D motion was measured using an optical motion capturing system. Results Significantly less motion at the implant-endplate interface was found for the two-piece cage (1.0°± 0.6°) in comparison to the one-piece cage (4.2°± 1.7°) in flexion/ extension. No significant differences in segment rigidity were found between the one-piece and two-piece cages in the 360°setup, while both configurations significantly reduced the range of motion compared to the intact condition (p \ 0.05). Conclusion In comparison to the traditional one-piece ALIF cages, the two-piece cage concept reduced the relative motion at the bone-implant interface without compromising stability.

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Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up

Cited by 99 publications

References 133 publications

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

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

Lumbar disc replacement surgery—successes and obstacles to widespread adoption

Two-piece ALIF cage optimizes the bone–implant interface in a 360° setting

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