Strube Patrick, Hoff Eike K, Perka Carsten F, Gross Christian, Putzier Michael
Clinic for Orthopaedics, Centrum für Muskuloskeletale Chirurgie, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Clin Spine Surg. 2016 Aug;29(7):291-9. doi: 10.1097/BSD.0b013e31827f434e.
Retrospective analysis of clinical and radiologic data of a prospective cohort study.
To research the clinical differences after lumbar total disk replacement (TDR) with respect to the preoperative global and the adaptation at the local sagittal profile (SP) of the spine.
It was suggested that facet loads and degeneration are dependent on epidemiologically defined types of SP. Moreover, the success of TDR was related to segmental facet joint loads. The influences of the preoperative SP or of the changes of the local SP after TDR on the clinical outcome after TDR remain unclear.
Fifty-two patients included in a prospective cohort study regarding lumbar single-level TDR L4/5 (n=22) or L5/S1 (n=30) because of degenerative disk disease (Modic ≤2 degrees) were clinically (visual analog scale for back, leg, and overall pain; Oswestry Disability Index) and radiologically (extension-flexion radiographs, plain-spine, and whole-spine lateral radiographs in upright standing position) reevaluated after a minimum follow-up of 24 (24-69) months. On the basis of preoperative plain radiographs in upright standing position, patients were retrospectively assigned to 4 groups according to the individual sagittal profile type (SPT). In patients with persistent back pain, a facet infiltration at the index level was performed.
For all patients, an SPT could be defined. Global SP did not change compared with the preoperative state. All groups improved clinically over follow-up. At the last follow-up, types 1 and 4 demonstrated significantly inferior scores for pain and function. TDR-induced changes at the superior adjacent segment and the posterior disk height at the index level were also correlated to inferior clinical results. Infiltration test was positive in type 1-4: 67%, 40%, 33%, and 75%, respectively, of the symptomatic patients.
We suggest SPTs 1 and 4 to represent a contraindication for lumbar TDR of levels L4/5 or L5/S1. Local adaptation in the adjacent segment to TDR may influence the clinical outcome as well.
对一项前瞻性队列研究的临床和放射学数据进行回顾性分析。
研究腰椎全椎间盘置换术（TDR）后在术前整体情况以及脊柱局部矢状面（SP）适应性方面的临床差异。
有研究表明小关节负荷和退变取决于流行病学定义的SP类型。此外，TDR的成功与节段性小关节负荷有关。术前SP或TDR后局部SP的变化对TDR术后临床结果的影响仍不明确。
对因退行性椎间盘疾病（Modic≤2级）而纳入腰椎单节段TDR（L4/5，n = 22；或L5/S1，n = 30）前瞻性队列研究的52例患者，在至少随访24（24 - 69）个月后进行临床（背部、腿部和总体疼痛的视觉模拟评分；Oswestry功能障碍指数）和放射学（屈伸位X线片、平片脊柱以及站立位全脊柱侧位X线片）重新评估。根据术前站立位平片，患者根据个体矢状面类型（SPT）被回顾性分为4组。对于持续存在背痛的患者，在索引节段进行小关节浸润。
所有患者均可定义SPT。与术前状态相比，整体SP未发生变化。所有组在随访期间临床情况均有改善。在最后一次随访时，1型和4型在疼痛和功能方面的评分显著较低。TDR引起的上位相邻节段变化以及索引节段的后椎间盘高度也与较差的临床结果相关。浸润试验在1 - 4型中有症状患者中的阳性率分别为67%、40%、33%和75%。
我们建议1型和4型SPT代表L4/5或L5/S1节段腰椎TDR的禁忌证。TDR相邻节段的局部适应性也可能影响临床结果。
