Chin Kingsley R
Department of Orthopaedics, Spine Surgery Service, 2 Silverstein, 3400 Spruce Street, University of Pennsylvania, Philadelphia, PA 19104, USA.
Spine J. 2007 Jul-Aug;7(4):392-8. doi: 10.1016/j.spinee.2006.08.009. Epub 2007 Feb 12.
Given the experience with anterior lumbar cages, the similar enthusiasm for total disc replacement (TDR) and the economic incentives driving use of this new technology, it is important to document reasonable expectations as to the incidence of patients with appropriate indications for this new technology.
To document epidemiological data for the indications and contraindications to total disc replacement (TDR) to guide expectations for use of this new technology. STUDY DESIGN/SETTINGS: Retrospective evaluation of contraindications and indications for lumbar TDR in consecutive symptomatic patients presenting to an academic spine practice.
Six hundred twenty-seven consecutive symptomatic patients presenting to an academic spine service.
Presence of contraindications to lumbar TDR based on Food and Drug Administration criteria.
Over a year, 627 new patients were evaluated by the only orthopedic spine surgeon on faculty at a major university. 131 underwent lumbar surgeries. Surgical patients were divided into Group 1 (57 patients who had fusions) and Group 2 (74 patients who had nonfusion surgeries). The incidence (period prevalence) and prevalence (point prevalence) of indications for and contraindications to TDR were documented.
The incidence of indications for TDR was 0.5% (3/627). The prevalence of no contraindications to TDR in the fusion Group 1 was 5% (3/57). Overall, 9% (3 fusion and 9 nonfusion) had no contraindications to TDR and the same percentage satisfied indications for TDR. However, 96% (71/74) of Group 2 patients considered themselves satisfied with laminectomies and laminotomies. The combined average number of contraindications to TDR was 2 (SD, 1.33) (range, 0-6). For Group 1, it was 3 and 1 for Group 2 (p<.5).
Despite early enthusiasm for TDR replacing fusion, there was only a 0.5% incidence of indications for TDR in the overall population and a 5% prevalence in the fusion patients, but the majority were in young patients who averaged about 38 years old. The absence of contraindications for TDR did not equate to indications for TDR because other nonfusion techniques exist. Based on the history of the introduction of other new spinal technologies and the fact that the current criteria for TDR seems to result in a relatively small number of eligible patients, there is risk of overuse of this new technology.
鉴于前路腰椎椎间融合器的应用经验、对全椎间盘置换术（TDR）的类似热情以及推动这项新技术应用的经济诱因，记录对这项新技术有适当适应证患者的发病率的合理预期很重要。
记录全椎间盘置换术（TDR）的适应证和禁忌证的流行病学数据，以指导对这项新技术应用的预期。研究设计/环境：对一家学术性脊柱诊疗机构中连续出现症状的患者进行腰椎TDR禁忌证和适应证的回顾性评估。
627名连续出现症状的患者到一家学术性脊柱诊疗机构就诊。
根据美国食品药品监督管理局标准确定腰椎TDR的禁忌证情况。
在一年时间里，一所主要大学的唯一一名骨科脊柱外科医生对627名新患者进行了评估。131名患者接受了腰椎手术。手术患者被分为第1组（57名接受融合手术的患者）和第2组（74名接受非融合手术的患者）。记录TDR适应证和禁忌证的发病率（期间患病率）和患病率（时点患病率）。
TDR适应证的发病率为0.5%（3/627）。在第1组融合手术患者中，无TDR禁忌证的患病率为5%（3/57）。总体而言，9%（3名融合手术患者和9名非融合手术患者）无TDR禁忌证，且相同比例的患者符合TDR适应证。然而，第2组96%（71/74）的患者认为自己对椎板切除术和椎板切开术感到满意。TDR禁忌证的合并平均数为2（标准差，1.33）（范围，0 - 6）。第1组为3，第2组为1（p<0.5）。
尽管早期对TDR取代融合手术充满热情，但在总体人群中TDR适应证的发病率仅为0.5%，在融合手术患者中的患病率为5%，但大多数是平均年龄约38岁的年轻患者。无TDR禁忌证并不等同于有TDR适应证，因为还存在其他非融合技术。基于其他新脊柱技术的引入历史以及当前TDR标准似乎导致符合条件的患者数量相对较少这一事实，这项新技术存在过度使用的风险。
