Rasouli Alexandre, Cuellar Jason M, Kanim Lea, Delamarter Rick
Cedars-Sinai Spine Center, Los Angeles, CA.
Clin Spine Surg. 2019 Feb;32(1):38-42. doi: 10.1097/BSD.0000000000000704.
Recent studies demonstrate the efficacy of lumbar arthroplasty using the ProDisc-L. Patients frequently present with multilevel pathology and may be candidates for multilevel disk replacement.
To evaluate clinical outcomes and sagittal range of motion of operated levels and adjacent lumbar motion segments in multiple-level ProDisc-L constructs after 2-6 years follow-up.
A total of 159 patients underwent adjacent 2-level (n=114), 3-level (n=41), or 4-level (n=4) lumbar total disk replacement (TDR).
STUDY-DESIGN: This is a prospective cohort.
Clinical measures: Oswestry Disability Index and Visual Analog Score of patient satisfaction (VAS-S) and pain (VAS-P) data were collected. Radiographic measures: sagittal motion on preoperative and postoperative lumbar radiographs at each operative segment and adjacent segment.
Patients were evaluated with radiographic and clinical outcomes measures preoperatively, at 6 weeks, 3 months, 6 months, and annually for 24-72 months postoperatively.
Radiographic: at the motion segment adjacent to the TDR, mean preoperative range of motion (ROM) was 8.20±2.88 degrees, compared with 8.40±2.4 degrees postoperatively at last follow-up (P>0.05). Between the 3 TDR groups, there were no significant differences in ROM at any time point except at L5-S1. Across both groups for TDR motion segments, the mean preoperative ROM was 10.15±2.71 versus 12.30±2.25 degrees postoperatively (P=0.011) at last follow-up. At L5-S1 mean preoperative motion was 7.60±3.90 versus 5.81±3.1 degrees postoperatively (P=0.60). Clinical: at 24-72 months postoperatively, all patients had significant reductions in Oswestry Disability Index, VAS-P, and VAS-S scores (P<0.05). At up to 72 months of follow-up, no patient underwent adjacent-level surgery but there were 3 cases of index-level revision surgery.
Multilevel TDR preserves ROM at the individual TDR levels. Most significantly, the nonoperative adjacent level maintains its preoperative ROM at 2-6 years postoperatively. At up to 6 years of follow-up, there has been no need for revision or adjacent-segment surgery. Patients also demonstrate significant improvement in pain and disability at latest follow-up.
近期研究证实了使用ProDisc-L进行腰椎置换术的疗效。患者常存在多节段病变，可能适合进行多节段椎间盘置换。
评估在2至6年随访后，多节段ProDisc-L植入物手术节段及相邻腰椎运动节段的临床疗效和矢状面活动度。
共有159例患者接受了相邻2节段（n = 114）、3节段（n = 41）或4节段（n = 4）的腰椎全椎间盘置换（TDR）。
这是一项前瞻性队列研究。
临床指标：收集Oswestry功能障碍指数、患者满意度视觉模拟评分（VAS-S）和疼痛视觉模拟评分（VAS-P）数据。影像学指标：每个手术节段及相邻节段术前和术后腰椎X线片上的矢状面活动度。
对患者在术前、术后6周、3个月、6个月以及术后24至72个月每年进行影像学和临床疗效评估。
影像学：在TDR相邻的运动节段，术前平均活动度（ROM）为8.20±2.88度，末次随访时术后为8.40±2.4度（P>0.05）。在3个TDR组之间，除L5-S1外，任何时间点的ROM均无显著差异。在两组TDR运动节段中，末次随访时术前平均ROM为10.15±2.71度，术后为12.30±2.25度（P = 0.011）。在L5-S1，术前平均活动度为7.60±3.90度，术后为5.81±3.1度（P = 0.60）。临床：术后24至72个月，所有患者的Oswestry功能障碍指数、VAS-P和VAS-S评分均显著降低（P<0.05）。在长达72个月的随访中，没有患者接受相邻节段手术，但有3例进行了索引节段翻修手术。
多节段TDR可保留各TDR节段的ROM。最重要的是，未手术的相邻节段在术后2至6年保持其术前ROM。在长达6年的随访中，无需进行翻修或相邻节段手术。患者在最近一次随访时疼痛和功能障碍也有显著改善。
