Purpose of the study: The purpose of this work was to analysis the clinical results of lumbar disc arthroplasty as a function of the type of degenerative discopathy in patients with MODIC 1 anomalies at the MRI.

Material and methods: Sixty-five patients were included in this prospective study over a two-year period. Mean age was 43 years (range 23–59). All patients had a single level lumbar discopathy with MODIC 1 signs on the MRI. The discopathy was classed H0 for isolated degenerative disc disease, H1 for an associated disc overhang, H2 in the event of a recurrent disc hernia, and H3 if there was a post-discectomy syndrome. The clinical analysis was based on the VAS for lumbar and radicular pain and the Oswestry score noted preoperatively then at 3, 6, 12 and 24 months postoperatively.

Results: In the 12 patients classed H0, a significant decrease in the lumbar and radicular VAS was noted at 24 months, similarly for the H1 patients (n=25), the H2 patients (n=12) and the H3 patients (n=16). The Oswestry score also improved significantly in the different groups: 25/50 preoperatively to 5/50 at last follow-up in H0, 25/50 to 7/50 in H1, 27/50 to 11/50 in H2, and 31/50 to 13/50 in H3. There was a statistically significant difference between the results in H0 and H3 and between H1 and H3 (p< 0.05).

Discussion: In patients with degenerative discopathy with MODIC1 signs on the MRI, the results of disc arthroplasty are globally satisfactory with a significant clinical improvement. There are however statistically significant difference as a function of the type of discopathy. These preliminary data provide a base for reflection concerning the expected results and about information to give patients for whom a lumbar disc arthroplasty may be proposed.

Study Design and Objectives: The aim of this prospective study is to analyze clinical results of lumbar total disc arthroplasty according to the MRI evaluation of the disc degeneration.

Summary of Background Data: Disc degeneration of the lumbar spine is associated with different signs on MRI study. Such lesions can be treated by spinal fusion or disc arthroplasty, and no strong therapeutic consensus is available at the moment. Non-fusion techniques have been developed for the treatment of disc degeneration disease and are able to preserve intervertebral mobility with good clinical results.

Materials and Methods: 221 patients with a mean age of 42 years have been included in this study. 107 patients were classified Modic 0, 65 Modic 1 and 49 Modic 2. Clinical evaluation (Oswestry Disability Index, Lumbar and Radicular visual analogic score) was performed preoperatively and at 3, 6, 12 and 24 months postoperatively.

Results: Mean follow-up of the series was 30 months [24–72 months]. A significant clinical improvement (p< 0, 05) was observed on each criteria between the preoperative evaluation and last follow-up. On the multivariate analysis between the three groups, a significant difference was observed, with better clinical results in the group classified Modic 1.

Conclusion: Total lumbar disc arthroplasty provide a significant clinical improvement in patients with disc degenerative disease with a minimum follow-up of two years. Best results were achieved in the group of patients classified as Modic 1 on the MRI evaluation. These results are applicable for the selection of indications of total disc arthroplasty and also for the patient information preoperatively.

Study Design and Objectives: The aim of this study is to analyse clinical results of total lumbar disc arthroplasty according to the type of disc degeneration.

Summary of Background Data: Lumbar disc degeneration can be associated with different causes of disc disease. Therapeutical management of such pathologies is still controversial between spinal fusion and arthroplasty. Non fusion techniques have been developed to allow a treatment of disc degeneration with a preserved intervertebral mobility.

Materials and Methods: 221 patients with a mean age of 42 years were included in this study with a prospective data collection. 54 patients were classified as H0 (primary disc degeneration without previous surgery), 98 were classified as H1 (disc degeneration with associated herniation, without previous surgery), 36 were as H2 (disc degeneration with recurrence of disc herniation, with previous surgery) and 33 patients were H3 (post-discectomy syndrome with previous surgery). Clinical evaluation was based on Oswestry Disability Index (ODI), Lumbar and Radicular Visual Analogic Scale (VAS), each measurement was performed preoperatively, and at 3, 6, 12 and 24 months postoperatively.

Results: Mean follow-up of the series was 30 months [24–72 months]. A significant (p< 0.05) clinical improvement was found between preoperative and the last follow-up evaluation for each group. On a multivariate analysis between different groups, a significantly higher ODI was found in the group classified as H3 (post-discectomy syndrome) at the final follow-up.

Conclusion: Total lumbar disc arthroplasty provides a significant clinical improvement for patients with disc degenerative disease, with a 2 year minimal follow-up. The poorest results were found in patients with previous surgical procedure on the concerned level (post-discectomy syndrome). These results can be helpful for selection of total disc arthroplasty indications and for the information that a surgeon must give to his or her own patient on the expected result after disc replacement.

Introduction: The choice of a procedure for the treatment of hallux rigidus depends on the severity of the disease, patient activity level, and expectations about the surgery. For patients who have severe hallux rigidus, arthrodesis has shown good results. On the opposite the results of joint-preserving procedures are less frequently presented.

Material et Methods: The following study concerns 113 cases of hallux rigidus with a mean age of 58 years. Seventy seven percent of the patients underwent arthrodesis of the first metatarsophalangeal joint, 23 % of them had a joint preserving procedure : phalangeal osteotomy and cheilectomy and were reviewed at an average 69 months postoperatively.

Results: The patients were assessed according to the AOFAS score. In the group, which had an arthrodesis, the results were satisfactory in 85 % of the cases. In the joint preserving technique group, 80% of patients were completely satisfied, 15% were satisfied with reservation, and 5% were dissatisfied. One patient suffered continued metatarsophalangeal joint pain that led to an arthrodesis after 10 years.

Discussion: First metatarsal decompression osteotomy are known for increasing joint range of motion but the risk of complication and patient dissatisfaction is less after phalangeal osteotomy.The clinical results are frequently not correlated with the radiological data.

Conclusion: Cheilectomy is classically proposed with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Nevertheless, in our experience we proposed as an alternative to a joint preserving procedure always an arthrodesis which functional results seemed more reliable. These results encourage us in being less restrictive in the indication for a joint preserving procedure.