EARLY AND MID TERM RESULTS AFTER TOTAL DISC REPLACEMENT: A PROSPECTIVE STUDY

Abstract

Purpose: In this prospective study we present the intermediate results of our experience using the Prodisc disc replacement for lumbar degenerative disc disease.

Methods and Results: A total of 29 patients underwent Prodisc disc replacement by the senior author(AAH). There were 9 males and 20 females with a mean age of 39 years(Range 28–60 years). 18 patients had a single level disc replacement (L5/S1-- 14 patients, L4/5-- 4 patients). 11 patients had double level disc replacement (L4/5& L5/S1--7 patients, L3/4& L4/5--3 patients, L2/3& L3/4--1 patient). All patients were assessed pre-operatively with clinical examination, plain films, MRI scans and discography. The indication for surgery was discogenic pain at one or two adjacent segments confirmed with discography, minimum six months of conservative treatment, 20–60 years of age and an Oswestry score > 40%. All patients also agreed to a prearranged follow up protocol. Follow up included clinical examination, plain films and subjective evaluation using the Oswestry scale, Visual Analogue Scale and SF 36 scoring system at 6 weeks, 3 months, 6 months and annually.

Results- The follow up range was from 3 months to 2 years. 26 patients had excellent to very good results and 2 patients had good results. There was one complication at 3 months post operatively. This patient sustained a fractured pedicle and underwent revision surgery involving removal of the prosthesis and Anterior Lumbar Fusion. At 6 months post revision a CT scan confirmed fusion. Rapid recovery was the most noticeable aspect of this study as well as rapid return to normal activities.

Conclusion: The Prodisc disc replacement is a good treatment option for lumbar degenerative disc disease provided the operative indications are strictly adhered to. The early and mid term results presented are encouraging, however close follow up of these patients is essential to ascertain the long term results.