Abstract
This is a prospective review of the results of our first 20 Prodisk disc replacements. The prosthesis is designed to maintain lumbar motion and, in theory, to avoid adjacent disc overload.
Nine men and 11 women scheduled for fusion were given the option of arthroplasty. The advantages and disadvantages were explained, as well as the ‘experimental’ nature of the product. Six (30%) of the 20 were Workmen’s Compensation patients. Permission to use patient data was obtained. The mean follow-up was 18 months. All patients completed a back pain questionnaire at initial and last follow-up. Preoperative and postoperative visual analogue scores (VAS) were recorded. The length of time to return to work was documented. All patients presented with severe low back pain and 12 had radiculopathy. All had positive discograms.
The senior author performed the operations after appropriate training, and a vascular surgeon assisted with the exposure. All cases were single level replacements, one at L3/L4, six at L4/L5 and 13 at L5/S1.
The mean preoperative VAS score was 8.6. Postoperatively it was 2.6. Mean anaesthesia time was 100 minutes (55 to 120). In patients other than pensioners, the time to return to work averaged 8 weeks. A special forces policeman and a military helicopter pilot both returned to their pre-injury levels of activity and another patient returned to first league basketball. No serious intraoperative complications occurred. One patient developed DVT in spite of prophylactic Enoxiparine. One ‘upper plate’ dislodged slightly at 20 months. The reason is unclear but the patient remains asymptomatic.
In selected patients, a Prodisk disc replacement is an excellent alternative to fusion, but it is imperative that the guidelines for indications are carefully followed.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
