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ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases
BACKGROUND: Total disc replacement (TDR) promises preservation of spine biomechanics in the treatment of degenerative disc disease but requires more careful device placement than tradition fusion and potentially has a more challenging learning curve. METHODS: A cohort of 44 consecutive patients had...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society for the Advancement of Spine Surgery
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300900/ https://www.ncbi.nlm.nih.gov/pubmed/25694889 http://dx.doi.org/10.1016/j.ijsp.2012.07.001 |
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author | Low, Jeffrey B. Du, Jerry Zhang, Kai Yue, James J. |
author_facet | Low, Jeffrey B. Du, Jerry Zhang, Kai Yue, James J. |
author_sort | Low, Jeffrey B. |
collection | PubMed |
description | BACKGROUND: Total disc replacement (TDR) promises preservation of spine biomechanics in the treatment of degenerative disc disease but requires more careful device placement than tradition fusion and potentially has a more challenging learning curve. METHODS: A cohort of 44 consecutive patients had 1-level lumbar disc replacement surgery at a single institution by a single surgeon. Patients were followed up clinically and radiographically for 24 months. Patients were divided into 2 groups of 22 sequential cases each. Clinically, preoperative and postoperative Oswestry Disability Index, visual analog scale, Short Form 12 (SF-12) Mental and Physical Components, and postoperative satisfaction were measured. Radiographically, preoperative and postoperative range of motion (ROM) dimensions, prosthesis deviation from the midline, and disc height were measured. TDR-related complications were noted. Logarithmic curve–fit regression analysis was used to assess the learning curve. RESULTS: Operative time decreased as cases progressed, with an asymptote after 22 cases. The operative time for the later group was significantly lower (P < .0005), but hospital stay was significantly longer (P = .03). There was no significant difference in amount of blood loss (P = .10) or prosthesis midline deviation (P = .86). Clinically, there was no significant difference in postoperative scores between groups in Oswestry Disability Index (P = .63), visual analog scale (P = .45), SF-12 Mental Component (P = .66), SF-12 Physical Component (P = .75), or postoperative satisfaction (P = .92) at 24 months. Radiographically, there was no significant difference in improvement between groups in ROM (P = .67) or disc height (P = .87 for anterior and P = .13 for posterior) at 24 months. For both groups, there was significant improvement for all clinical outcomes and disc height over preoperative values. One patient in the later group had device failure with subluxation of the polyethylene, which required revision. CONCLUSIONS/LEVEL OF EVIDENCE: Early experience can quickly reduce operative time but does not affect clinical outcomes or ROM significantly (level IV case series). CLINICAL RELEVANCE: Lumbar TDR is a rapidly learnable technique in treatment of degenerative disc disease. |
format | Online Article Text |
id | pubmed-4300900 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | International Society for the Advancement of Spine Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-43009002015-02-18 ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases Low, Jeffrey B. Du, Jerry Zhang, Kai Yue, James J. Int J Spine Surg Full Length Article BACKGROUND: Total disc replacement (TDR) promises preservation of spine biomechanics in the treatment of degenerative disc disease but requires more careful device placement than tradition fusion and potentially has a more challenging learning curve. METHODS: A cohort of 44 consecutive patients had 1-level lumbar disc replacement surgery at a single institution by a single surgeon. Patients were followed up clinically and radiographically for 24 months. Patients were divided into 2 groups of 22 sequential cases each. Clinically, preoperative and postoperative Oswestry Disability Index, visual analog scale, Short Form 12 (SF-12) Mental and Physical Components, and postoperative satisfaction were measured. Radiographically, preoperative and postoperative range of motion (ROM) dimensions, prosthesis deviation from the midline, and disc height were measured. TDR-related complications were noted. Logarithmic curve–fit regression analysis was used to assess the learning curve. RESULTS: Operative time decreased as cases progressed, with an asymptote after 22 cases. The operative time for the later group was significantly lower (P < .0005), but hospital stay was significantly longer (P = .03). There was no significant difference in amount of blood loss (P = .10) or prosthesis midline deviation (P = .86). Clinically, there was no significant difference in postoperative scores between groups in Oswestry Disability Index (P = .63), visual analog scale (P = .45), SF-12 Mental Component (P = .66), SF-12 Physical Component (P = .75), or postoperative satisfaction (P = .92) at 24 months. Radiographically, there was no significant difference in improvement between groups in ROM (P = .67) or disc height (P = .87 for anterior and P = .13 for posterior) at 24 months. For both groups, there was significant improvement for all clinical outcomes and disc height over preoperative values. One patient in the later group had device failure with subluxation of the polyethylene, which required revision. CONCLUSIONS/LEVEL OF EVIDENCE: Early experience can quickly reduce operative time but does not affect clinical outcomes or ROM significantly (level IV case series). CLINICAL RELEVANCE: Lumbar TDR is a rapidly learnable technique in treatment of degenerative disc disease. International Society for the Advancement of Spine Surgery 2012-12-01 /pmc/articles/PMC4300900/ /pubmed/25694889 http://dx.doi.org/10.1016/j.ijsp.2012.07.001 Text en © 2012 ISASS - International Society for the Advancement of Spine Surgery. Published by Elsevier Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Full Length Article Low, Jeffrey B. Du, Jerry Zhang, Kai Yue, James J. ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases |
title | ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases |
title_full | ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases |
title_fullStr | ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases |
title_full_unstemmed | ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases |
title_short | ProDisc-L learning curve: 24-Month clinical and radiographic outcomes in 44 consecutive cases |
title_sort | prodisc-l learning curve: 24-month clinical and radiographic outcomes in 44 consecutive cases |
topic | Full Length Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300900/ https://www.ncbi.nlm.nih.gov/pubmed/25694889 http://dx.doi.org/10.1016/j.ijsp.2012.07.001 |
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