Factors Affecting Motion After Lumbar Disc Replacement

Total disc replacement (TDR) has become a new option for patients with degenerative disc disease (DDD). It may replace spinal fusion. The obvious advantage is maintaining range of motion (ROM). There's still some concern about what happens to motion in the spine below the level of the TDR.

In this study, surgeons from Korea study X-rays to see what affect TDR has on the lumbar spine. They also looked for any factors that might influence the results of surgery. Patients having the TDR were followed for at least two years.

All patients included in the study had severe pain from DDD that wouldn't go away with any form of treatment. The lumbar levels affected were between L3 and S1. The disc was replaced with the ProDisc II prosthesis. The same surgeon did all the operations.

Digital X-rays were taken before and after the surgery. A computer program was used to take and analyze various measurements. Several factors were evaluated to see if they might influence ROM. These included age, sex, body mass index, and motion before surgery. The level of the implant was also included as a possible factor affecting the results.

The authors found that ROM at the L5-S1 segment was less than at other levels with this particular implant device. They suspect this difference can be explained by the unique anatomy of the L5-S1 segment. There are many ligaments and an increased stiffness in this zone. This is where the lumbar spine is connected to the sacrum.

Other factors had no value in predicting the results. ROM before surgery did not seem to affect motion afterwards. This result suggests that diseased segments with decreased ROM could benefit from TDR. The authors plan to study and report the outcomes over a much longer period.

Dong-Hyun Kim, M.D., et al. Factors Influencing Segmental Range of Motion After Lumbar Total Disc Replacement Using the ProDisc II Prosthesis. In Journal of Neurosurgery: Spine. August 2007. Vol. 7. No. 2. Pp. 131-138.

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