Adjacent level degeneration and facet arthropathy after disc prosthesis surgery or rehabilitation in patients with chronic low back pain and degenerative disc: second report of a randomized study.

STUDY DESIGN

Randomized clinical trial with 2-year follow-up.

OBJECTIVE

To assess the development of adjacent level degeneration (ALD) and index level facet arthropathy (FA) in patients treated with disc prosthesis compared with patients treated with rehabilitation.

SUMMARY OF BACKGROUND DATA

There is controversy about the natural history of disc degeneration and the development of ALD and FA in patients who undergo disc prosthesis surgery.

METHODS

The study included 116 patients with a history of low back pain for at least 1 year, Oswestry Disability Index 30 points or more, and degenerative changes in 1 or 2 lower lumbar spine levels. Magnetic resonance imaging was performed before treatment and at the 2-year follow-up. ALD and index level FA were determined on the basis of the majority assessment of 3, independent, experienced radiologists. ALD was assessed by evaluating Modic changes, posterior high intensity zone in the disc, nucleus pulposus signal, disc height, disc contour, and FA. Data were analyzed with Fischer exact test and t test.

RESULTS

ALD developed with similar frequencies in patients who were (n = 59) and were not (n = 57) treated with surgery. In patients treated with surgery, index level FA appeared or increased in 20 patients (34%) and decreased in 1 patient. In patients treated with rehabilitation, 2 (4%) had new or increased FA at the index/degenerated disc level and 1 had decreased FA (P < 0.001). The development of ALD and FA was not related to clinical outcome.

CONCLUSION

In this first study that compared the courses of degeneration after treatment with disc prosthesis surgery or rehabilitation, ALD was observed at similar frequencies at the 2-year follow-up. However, the surgery group had increased FA at the implant level.