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.
The purpose of this study was to evaluate the use of spinal rehabilitation services in Gauteng Province. During the period November 2001 to March 2002 we sent a questionnaire to all hospitals under the control of the Gauteng Health Department. Identified individuals in each hospital completed the questionnaires. The results were analysed statistically. A mean 153 patients were admitted every month. On average, traumatic penetrating injuries accounted for 64 patients, fractures for 52, infectious diseases for 14, tumours for eight, vascular compromise for one, miscellaneous causes for five and readmissions for nine. On average, four patients died after admission. The majority (61%) of readmissions were because of pressure sores. Every month a mean 24 patients were discharged. Neurological levels were as follows: incomplete paraplegia 19%, complete paraplegia 45%, complete quadriplegia 19%, incomplete quadriplegia 17%. The mean length of stay was 44 days. Traumatic penetrating injury called for a mean stay of 63 days, fracture 81 days, infectious diseases 56 days, tumours 49 days, vascular problems six days and other causes eight days. Only 53% of patients were admitted to a spinal unit, while 36% were treated in general wards and 11% were admitted to ‘rehabilitation beds’. We believe that spinal rehabilitation needs to be recognised as a specialised field. More rehabilitation beds are needed. Referral routes to dedicated spinal units need to be improved and available facilities optimally used and distributed.
