Total lumbar disc replacement in athletes: clinical results, return to sport and athletic performance

Siepe, Christoph J.; Wiechert, Karsten; Khattab, Mohamed Fawzy; Korge, Andreas; Mayer, H. M.

doi:10.1007/s00586-006-0257-y

Cited by 58 publications

(43 citation statements)

References 61 publications

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“…Despite this, he was able to return to full duty 22 weeks after his initial surgery. This is comparable with the experience reported by Siepe et al 19 who reviewed data obtained after lumbar arthroplasty in athletes. In their series of 39 athletes, they identified that peak performance was reached at 5.2 months after surgery, with 37 (94.9%) of the 39 resuming their previous sporting activity.…”

Section: Lumbar Spine: Performance Statussupporting

confidence: 91%

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Arthroplasty in the military: a preliminary experience with ProDisc-C and ProDisc-L

Tumialán¹,

Ponton²,

Garvin³

et al. 2010

FOC

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Object The introduction of cervical and lumbar arthroplasty has allowed for management of cervical radiculopathy and lumbar degenerative disease in patients with the preservation of motion at the affected segment. While the early clinical outcomes of this technology appear promising, it remains unclear what activity limitations should be imposed after surgery in patients with these implants. This is of particular interest in military personnel, who may be required to return to a rigorous level of activity after surgery. The goals of the FDA trials evaluating various disc arthroplasty devices were to establish safety, efficacy, and equivalency to arthrodesis. Information regarding the level of physical performance attained and restrictions or limitations is lacking, as these were outside the objectives of these trials. Nevertheless, there data are essential for the military surgeon, who is tasked with guiding the postoperative management of patients treated with arthroplasty and returning them to full duty. While there is a single report of clinical results of lumbar arthroplasty in athletes, at this writing, there are no reports of either cervical or lumbar arthroplasty in active duty military personnel. Methods The surgical database at a single, tertiary care military treatment facility was queried for all activeduty patients who underwent placement of either a cervical or lumbar arthroplasty device over a 3-year period. The authors performed a retrospective chart review to collect patient and procedural data including blood loss, length of hospital stay, tobacco use, age, rank, complications, and ability to return to full unrestricted active duty. Arthroplasty cohorts were then compared to historical controls of arthrodesis to ascertain differences in the time required to return to full duty. Results Twelve patients were identified who underwent cervical arthroplasty. All patients returned to unrestricted full duty. This cohort was then compared with 12 patients who had undergone a single-level anterior cervical discectomy and fusion. The average time to return to unrestricted full duty for the arthroplasty group was 10.3 weeks (range 7–13 weeks), whereas that in the fusion group was 16.5 weeks. This difference between these 2 groups was statistically significant (p = 0.008). Twelve patients were identified who underwent lumbar arthroplasty. Ten (83%) of 12 patients in this group returned to unrestricted full duty. In patients who returned to full duty, it took an average of 22.6 weeks (range 12–29 weeks). This cohort was then compared with one in which patients had undergone anterior lumbar interbody fusion. Eight (67%) of 12 patients in the lumbar arthrodesis group returned to unrestricted full duty. In patients who returned to full duty, it took an average of 32.4 weeks (range 25–41 weeks). This difference was not statistically significant (p = 0.156). Conclusions The preliminary experience with cervical and lumbar arthroplasty at the authors' institution indicates that arthroplasty is comparable with arthrodesis and may actually expedite return to active duty. Patients are capable of returning to a high level of rigorous training and physical performance. There are no apparent restrictions or limitations that are required after 3 months in the cervical patient and after 6 months in the lumbar patient. Further prospective studies with long-term follow-up are indicated and will be of value when determining the role of arthroplasty compared to arthrodesis in the active-duty population.

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Section: Lumbar Spine: Performance Statussupporting

confidence: 91%

“…10,19,21 The magnitude of these forces remains largely unknown. This creates a difficulty in predicting the behavior of a modular implant, such as the ProDisc, under such conditions.…”

mentioning

confidence: 99%

Arthroplasty in the military: a preliminary experience with ProDisc-C and ProDisc-L

Tumialán¹,

Ponton²,

Garvin³

et al. 2010

FOC

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“…The reasons for sacroiliac joint pain following TDR remain unknown. A variety of recently published studies have reported low ROM-values [28,37,59]. The pathomechanism of postoperative ISJ pain in these patients may therefore be similar to that of lumbosacral fusion procedures [29,42,43].…”

Section: Diagnostic Challengesmentioning

confidence: 71%

“…Despite motion preservation in the majority of cases, a variety of recently published studies have reported low flexion/extension ROM-values in a considerable number of cases with unknown consequences [28,37,59]. Furthermore, implant positioning and disc-/implant-height have been shown to influence and increase post-operative segmental lordosis which may ultimately lead to a subluxation of the facet joints (Fig.…”

Section: Radiological Studiesmentioning

confidence: 99%

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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“…Lumbar total disc replacement · Meta-analysis · Short-and long-term results · Level of evidence Die Ergebnisse der prospektiven Studien bezüglich Patientenzufriedenheit, Reduktion der individuellen Beeinträch-tigungen (VAS und ODI) sind konsistent signifikant gebessert, wobei monosegmentale Versorgungen klinisch signifikant bessere Ergebnisse erzielen als bisegmentale Versorgungen mit den besten Resultaten bei L4/L5 [39]. Die Arbeitsfä-higkeit konnte innerhalb von 24 Monaten deutlich gesteigert werden [3,4,5,8,10,27,40,42,45] und auch die Sportfähig-keit bis hin zum Leistungssport ist über-wiegend erreichbar [40].…”

Section: Introductionunclassified

Lumbale Bandscheibenendoprothetik – Update 2008

Wiedenhöfer

Ewerbeck

Suda

et al. 2008

Chirurg

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Lumbar total disc replacement is an increasingly common way of treating degenerative lumbar disc disease while preserving mobility. The aim of this analysis was to survey evidence-based data to classify the procedure. Based on a MEDLINE inquiry, 38 clinical trials dealing with lumbar total disc replacement were selected and analyzed by the criteria of indication, preoperative procedure, and clinical follow-up. These data represent 3,180 patient-related evaluations with follow-up of 5.9 to 204 months. We also included ten retrospective studies. Patient satisfaction was a mean of 90.73%, and the Oswestry Disability Index and Visual Analog Scale were significantly lower. High rates of revision surgery, explantation surgery, and secondary fusions are linked to wrong preoperative indication. According to evidence criteria, the results show that lumbar total disc replacement is a safe procedure with a high rate of success. There is clear evidence that both imprecise indication and the choice of too-small implants significantly reduce the prospect of surgical success and increase the rates of reintervention.

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Total lumbar disc replacement in athletes: clinical results, return to sport and athletic performance

Cited by 58 publications

References 61 publications

Arthroplasty in the military: a preliminary experience with ProDisc-C and ProDisc-L

Arthroplasty in the military: a preliminary experience with ProDisc-C and ProDisc-L

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

Lumbale Bandscheibenendoprothetik – Update 2008

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