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.

Purpose of the study: The theoretical advantage of a disc prosthesis compared with fusion is to preserve spinal mobility. The purpose of our study was to determine the relationship, at nine years follow-up, between range of motion and clinical outcome after lumbar disc replacement.

Material and methods: This retrospective analysis concerned the clinical and radiographic outcome observed in 38 patients who had undergone one- or two-stage disc replacement surgery (51 implanted prostheses). Mean follow-up was 8.6 years (range 6.9–10.7). Clinical outcome was assessed with the Stauffer-Coventry modified score (SCM), the Oswestry score (ODQ) and a visual analog scale (VAS) for lumbar and radicular pain. Flexion-extension range of motion (ROM) was measured on the upright films (Cobb method) at last follow-up. Each clinical element was compared with the ROM (Spearman coefficient of correlation). Two groups of patients were distinguished: high (> 5°) and low ≤ 5°) ROM for comparison with the Mann-Whitney test.

Results: The Spearman coefficient of correlation disclosed a weak to moderate but statistically significant association between ROM, lumbar VAS (r=−0.35, p=0.034), ODQ (r=−0.33, p=0.046), SCM (r=0.42, p=0.0095); but no significant correlation between ROM and radicular VAS (r=−0.12,p=0.48). Patients with greater ROM had better clinical results and ODQ (mean difference 6.3 points, p=0.031) and SCM (mean difference 2.2 points, p=0.017); but no significant difference between the preoperative characteristics in each group (age, sex, weight, surgical history, lumbar and radicular pain, ODQ and SCM).

Discussion: There are no data in the literature comparing range of motion and clinical outcome after lumbar disc replacement. The present study demonstrated a weak to moderate but statistically significant relationship (r=0.35) between range of flexion-extension motion and clinical outcome at nine years. In addition, patients with lesser ROM (< 5°) have slightly less favorable results compared with those with greater ROM (> 5°). This study suggests the preservation of motion has a positive effect on mid-term clinical outcome.

Conclusion: These results need to be confirmed with long-term prospective data comparing discal prosthesis with fusion and non-surgical treatment in order to demonstrate the usefulness of preserving motion on the quality of the clinical outcome.

Purpose of the study: Discal arthroplasty is warranted as a part of the treatment of discopathy to guarantee mobility after disc removal. Depending on the type of discopathy, the diseased disc can be classified into different categories: absence of herniation (H0), disc herniation (H1), recurrent disc herniation (H2), post discectomy syndrome (H3), or stenosis of a single unit (including grade 1 degenerative spondylolisthesis) (St-SPd). The purpose of this study was to compare clinical outcome after discal arthroplasty for these different clinical situations.

Material and methods: This was a prospective study of 152 patients who underwent a single-stage operation for insertion of a lumbar disc prosthesis. Pain was assessed with a visual analog scale for the lumbar level (VAS-L), and for radicular pain (VAS-R) and the Oswestry index (ODI). Patients were classified as follows: 39 H0, 52 H1, 22 H2, 29 H3, 10 ST-SPd).

Results: Outcome in patients in groups H0, H1, and St-SPd, i.e. first-intention surgery patients, presented equivalent results for lumbar and radicular pain and for function: VAS-L and VAS-R declined concomitantly. Results at three months postop were equivalent to those observed at 24 months. Patients in groups H2 and H3 who had had prior operation(s) for posterior discectomy experienced rapid relief of lumbar pain but radicular pain persisted postoperatively (6 to 12 m).

Discussion: These data confirm the excellent results obtained with single-level disc replacement as assessed by VAS and ODI. The persistence of radiculalgia which then resolves several months later in patients with a history of discal surgery can be explained by the combination of chronic compression, postoperative adherences and restored disc height. In the present series, none of the patients required complementary surgery for posterior radicular release.

Conclusion: Discal arthroplasty provides satisfactory results for the different stages of discal disease. The procedure should however be undertaken with prudence for patients who have had prior surgery. A perfect analysis of other factors involved should be helpful in chosing the most appropriate technique and avoid the development of postoperative radiculalgia. The present results could be usefully confirmed with a long-term randomized prospective study comparing discal prosthesis with fusion for the treatment of discal disease.