Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People's Republic of China.
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 GongTiNanLu, Chaoyang, Beijing, 100020, People's Republic of China.
J Orthop Surg Res. 2021 Jan 4;16(1):2. doi: 10.1186/s13018-020-02116-4.
The effectiveness of lumbar total disc replacement (TDR) with different prostheses for sagittal alignment has been reported previously. However, there are only few reports on Activ L TDR and no specific evidence regarding whether sagittal alignment affects the clinical outcomes.
Eighty-seven patients who underwent mono- or bi-segmental lumbar TDR with Activ L were studied. The films of the upright anteroposterior and lateral spine in neutral, flexion, and extension positions were obtained before surgery and at 1 month and 1 and 3 years after surgery. The radiographic parameters such as lumbar lordosis (LL), index level lordosis (IL), pelvic incidence (PI), pelvic tilt (PT), segmental lordosis (SL), and sacral slope (SS) were measured based on the lateral upright radiographs. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) pre- and post-operatively.
Eighty-seven patients with complete radiographic data were available for a 3-year follow-up period. Of these, 66 received a single-level TDR, and 21 received a 2-level TDR. At 1 month, the mean LL was similar to the pre-operative data and then was significantly increased to 45.1° at 3 years. On average, the IL tended to significantly increase, while the mean SL at L-5 was increased from 16.5° pre-operatively to 21.0° at 3 years. The mean SL at L1-2, L2-3, L3-4, and L5-S1; PI; PT; and SS showed no obvious difference after 3 years. In contrast, VAS and ODI scores showed significant improvement after surgery.
Activ L TDR showed a favorable effect on sagittal alignment, enhancing the IL while preserving the LL and SS. However, satisfactory clinical results for over a 3-year follow-up were not affected by sagittal alignment.
已有研究报道了不同假体的腰椎全椎间盘置换术（TDR）在矢状面排列方面的效果。然而，关于 Activ L TDR 的报道很少，也没有关于矢状面排列是否会影响临床结果的具体证据。
研究了 87 例接受单节段或双节段腰椎 Activ L TDR 的患者。在术前、术后 1 个月及 1 年和 3 年时，分别获取中立位、前屈位和后伸位的正位前后位和侧位脊柱片。根据侧位直立位片测量腰椎前凸角（LL）、目标节段前凸角（IL）、骨盆入射角（PI）、骨盆倾斜角（PT）、节段前凸角（SL）和骶骨倾斜角（SS）等影像学参数。术前和术后采用 Oswestry 功能障碍指数（ODI）和视觉模拟评分（VAS）评估临床结果。
87 例患者有完整的影像学资料，随访时间为 3 年。其中 66 例接受单节段 TDR，21 例接受双节段 TDR。术后 1 个月时，LL 均值与术前相似，随后在术后 3 年时显著增加至 45.1°。IL 均值呈显著增加趋势，而 L5 节段 SL 从术前的 16.5°增加至术后 3 年时的 21.0°。L1-2、L2-3、L3-4 和 L5-S1 节段 SL、PI、PT 和 SS 均值在 3 年后无明显差异。相比之下，VAS 和 ODI 评分在手术后均有显著改善。
Activ L TDR 对矢状面排列有良好的效果，可增强 IL，同时保持 LL 和 SS。然而，超过 3 年的随访结果显示，满意的临床效果不受矢状面排列的影响。
