Abstract
Aim
NICE guidance on lumbar total disc replacement (TDR) recommends ongoing audit should be an integral part of disc replacement surgery. We present our ongoing audit data and the extent of problem of patients lost to follow up.
Method
35 patients underwent lumbar TDR surgery over 4.5 years. They were followed prospectively. A database is maintained and ODI and VAS were collected prospectively, including patient satisfaction and any failures.
Results
At latest follow up full data was available for 30 out of 35 patients. The mean follow-up was 34 months (range 3-52 months). There were 13 males with a mean age 37.7 years (range 27-62) and 17 females with a mean age of 49.8 years (range 27-62). Surgery was single level in 24 cases and double level in 6 cases. 21 patients rated their outcome as good or very good and 7 as unsatisfactory. There were 2 failures, one secondary to late extrusion of the polyethylene liner (12 months post-surgery) and one early anterior migration of the prosthesis. ODI scores improved by a mean of 28 points (range -4 to 68) whilst VAB scores improved by a mean of 4.9 (range -1 to 9). Five patients had been lost to follow up. One patient migrated out of the area. Two came from out of the area and did not return for follow up after the initial period and two further patients DNAed multiple clinic appointments.
Conclusion
We conclude that lumbar disc replacement surgery can provide substantial improvement in pain relief and function. Continued audit of this cohort of patients is essential to comply with NICE guidance. 14% loss to follow up/audit is encountered despite our best effort.
