Degenerative Changes of Discs and Facet Joints in Lumbar Total Disc Replacement Using ProDisc II: Minimum Two-Year Follow-up

Study Design. A retrospective clinical and radiologic data analysis. Objective. To determine the radiologic changes in the discs at the adjacent levels and facets at the index and adjacent levels after total disc replacement (TDR) using ProDisc II in a minimum 2-year follow-up. Summary of the Background Data. The main purposes of TDR are to preserve the physiologic segmental motion at index level, and to prevent accelerated degeneration at the index and adjacent segments. However, there are few reports dealing with the effects of TDR on the degenerative changes in a long-term follow-up. Methods. After TDR using ProDisc II, the degree of disc and facets degeneration at the index and adjacent levels was assessed by observing lumbar magnetic resonance imaging (MRI) and computed tomography (CT) images before surgery and at minimum 26 months after operations. The degenerative changes of the discs and facets were determined in relation to the clinical outcome, various perioperative factors, and prosthesis factors. Results. Thirty-two patients with 41 TDR included in this investigation. The progression of facets degeneration (PFA) was observed in 12 of 41 TDR levels. Among 47 adjacent segments, the progression of disc degeneration and PFA were observed in 2 levels (4.3%), and 3 levels (6.4%), respectively. All cases of PFA occurred only in those with preoperative degeneration of grade 1. PFA at the index segments was positively related with female in gender (P = 0.008), the malposition of prosthesis on frontal plane (P = 0.025), and 2-level TDR in the number of TDR level (P = 0.008). Conclusion. After TDR using ProDisc II, the degenerative changes in the discs and facets at the adjacent segments appeared to be minimal. However, in 29.3% of the TDR segments, the facet joints presented PFA, which was more common in female, malposition of prosthesis on frontal plane, and 2-level TDR in a minimum 2-year follow-up.

[1]  C. Pfirrmann,et al.  Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration , 2001, Spine.

[2]  M. Müller-Gerbl,et al.  A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITÉ™ Artificial Disc , 2006, European Spine Journal.

[3]  R. Bertagnoli,et al.  Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications , 2002, European Spine Journal.

[4]  S. L. Griffith,et al.  A Multicenter Retrospective Study of the Clinical Results of the LINK®SB CharitéA Intervertebral Prosthesis. The Initial European Experience , 1994, Spine.

[5]  François Lavaste,et al.  Clinical and Radiological Outcomes With the Charité™ Artificial Disc: A 10-Year Minimum Follow-Up , 2005, Journal of spinal disorders & techniques.

[6]  J. Le Huec,et al.  Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up. , 2005, The Orthopedic clinics of North America.

[7]  Dominik Weishaupt,et al.  MR imaging and CT in osteoarthritis of the lumbar facet joints , 1999, Skeletal Radiology.

[8]  S. Blumenthal,et al.  Artificial disc: preliminary results of a prospective study in the United States , 2002, European Spine Journal.

[9]  Andreas Korge,et al.  Clinical Results of Total Lumbar Disc Replacement With ProDisc II: Three-Year Results for Different Indications , 2006, Spine.

[10]  Moe R. Lim,et al.  Range of motion and adjacent level degeneration after lumbar total disc replacement. , 2004, The spine journal : official journal of the North American Spine Society.

[11]  C. Hopf,et al.  Der Bandscheibenersatz mit der SB Charité-Bandscheibenendoprothese - Erfahrungen, Frühergebnisse und Feststellungen nach 35 prospektiv durchgeführten Operationen , 2002 .

[12]  Marc-Antoine Rousseau,et al.  Disc arthroplasty design influences intervertebral kinematics and facet forces. , 2006, The spine journal : official journal of the North American Spine Society.

[13]  C. Hopf,et al.  [Disc replacement with the SB Charité endoposthesis - experience, preliminary results and comments after 35 prospectively performed operations]. , 2002, Zeitschrift für Orthopädie und ihre Grenzgebiete.

[14]  F. Girardi,et al.  Lumbar Disc Replacement: Preliminary Results with ProDisc II After a Minimum Follow-Up Period of 1 Year , 2003, Journal of spinal disorders & techniques.

[15]  F. Oner,et al.  Complications of Artificial Disc Replacement: A Report of 27 Patients with the SB Charité Disc , 2003, Journal of spinal disorders & techniques.

[16]  T. Friesem,et al.  Shock Absorption in Lumbar Disc Prosthesis: A Preliminary Mechanical Study , 2003, Journal of spinal disorders & techniques.

[17]  Paul Park,et al.  Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature , 2004, Spine.

[18]  Chun-Kun Park,et al.  Factors influencing segmental range of motion after lumbar total disc replacement using the ProDisc II prosthesis. , 2007, Journal of neurosurgery. Spine.

[19]  P. Brinckmann,et al.  Mobility of Lumbar Segments Instrumented With a ProDisc II Prosthesis: A Two-Year Follow-up Study , 2006, Spine.

[20]  Patrick Tropiano,et al.  Long-Term Flexion-Extension Range of Motion of the Prodisc Total Disc Replacement , 2003, Journal of spinal disorders & techniques.

[21]  R. Delamarter,et al.  Clinical results of ProDisc-II lumbar total disc replacement: report from the United States clinical trial. , 2005, The Orthopedic clinics of North America.

[22]  W C Hutton,et al.  Disc space narrowing and the lumbar facet joints. , 1984, The Journal of bone and joint surgery. British volume.

[23]  V. Goel,et al.  Load-Sharing Between Anterior and Posterior Elements in a Lumbar Motion Segment Implanted With an Artificial Disc , 2001, Spine.

[24]  W. Koopman.  Arthritis and allied conditions;: A textbook of rheumatology , 1972 .