Aims

Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse.

Purpose of the study. To compare safety and efficacy of cervical disc replacement (CRD) in single and multilevel DDD. Patients were followed up at 1, 3, 6, 12 and 24 months. Methods. 249 patients were enrolled. 171 patients were treated at 1-level, 41 treated at 2 levels and 2 patients were treated at 3 levels. Implant was also used adjacent to a fusion with a cage in 35 patients. The diagnosis was cervical degenerative disc disease between C3 and C7 with symptomatic DH. Population was 106 male 143 female, average age 46 (25-71). Clinical assessment included VAS scores for arm and neck pain and Neck Disability Index (NDI). Range of motion (ROM) from flexion/extension lateral view were measured. Results. Of all NDI scores recorded, 86,50 % demonstrated at least 15 points improvement at two years follow up from pre-op scores. 85,1% of VAS arm Pain scores demonstrated an improvement by = 2 points from pre-op scores and 50,8% for VAS neck Pain scores. The breakdown by levels and adjacent to an interbody cage shown that 80% of reported NDI scores demonstrated at least a 15 point improvement post operatively for two level disc replacement. 82,4% demonstrated a greater than 2 points improvement in VAS arm pain and 53,3% for VAS neck pain. For patients that received both implant and an interbody cage, 72,7% demonstrated a greater than 2 point improvement in VAS arm pain and 41,7% for VAS neck pain. Three (1,8%) cases of subsidence and 4 cases of implant loosening/displacement due to inappropriate sizing were reported. Available radiographic findings show on average a ROM of 8,2 ° at 2 years and an overall change in cervical lordosis of 5° from pre-op. Conclusion. Clinical outcomes demonstrated a significant improvement for both the total population (n=249) and for the single level total disc replacement population (n=171). Given these outstanding results single and multilevel TDR with this implant can be considered to be safe. No significant difference was observed between single and multilevel TDR groups regarding clinical, functional and radiological results. Follow up for this series need however to be extended for up to 5 years at least. The role of this implant in multilevel cases as well as in cases to a fused level still need further evaluation although these preliminary results are encouraging

Aims

The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation.