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Abstract
Purpose
To assess factors significantly affecting the range of motion of the lumbar spine at the operated segment following total disc replacement (TDR) arthroplasty.
Materials and Methods
Thirty-six patients (15 men and 21 women) who received lumbar TDR at a single level using Prodisc II (Spine Solutions Inc, New York, NY USA) were included in this study. The study included 23 cases at L4-5 and 13 cases at L5-S1. The average patient age was 43.6 years (range, 23-59 years) and the minimum follow-up was 24 months (range, 24-61 months). Two independent observers measured radiological parameters preoperatively, at 3 months postoperatively, and at the final follow-up. These parameters included disc height, affected level segmental range of motion (ROM) and prosthesis position and height. A radiologist independently measured facet joint degeneration and the fat contents of the paraspinal muscles on preoperative MR images. Clinical results were evaluated using the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS).
Results
Segmental ROM was well preserved at the final follow-up (preoperative, 11.3 degrees; 3 months postoperative 13.2 degrees; final follow up, 13.1 degrees). The factors found to affect segmental ROM significantly at the final follow-up were the preoperative ROM, preoperative disc height, disc height increment ratio and a history of previous back surgery on the affected disc (p<0.05). The VAS significantly improved in patients with increased segmental ROM at the operated level (p<0.05).
Conclusion
Statistical analysis showed that the factors affecting segmental ROM were the preoperative ROM, preoperative disc height, disc height increment ratio, and a history of previous back surgery on the affected disc. However, further effort needs to be directed towards an evaluation of a larger number of patients with a longer follow-up.
Figures and Tables
Fig. 1
Flexion-extension radiographs of a patient who underwent TDR implantation at L4-L5. The TDR ROM was measured using the Cobb method with the keels as radiographic landmarks in flexion and extension X-rays.
Fig. 3
Lateral flexion (A) and extension (B) radiographs at 4-years of a 40-year-old woman with the Prodisc II applied to L5-S1. Segmental ROM was 18°. Lumbarization of S1.
Table 1
(A) Grading of the Lumbar Facet Joint Degeneration Using Computed Tomography and Magnetic Resonance Imaging, as Described by Weishaupt et al. (B) Fat Content of the Lumbar Paraspinal Muscle, as Described by Goutallier et al.
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