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Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Total disc replacement (TDR) has been introduced in order to preserve segmental motion and thus reduce adjacent segment disease (ASD) as seen after spinal fusion. However, it is uncertain whether these presumed beneficial effects remain. The aim...

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Autores principales: Kitzen, Joep, Vercoulen, Timon F. G., Schotanus, Martijn G. M., van Kuijk, Sander M. J., Kort, Nanne P., van Rhijn, Lodewijk W., Willems, Paul C. P. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351064/
https://www.ncbi.nlm.nih.gov/pubmed/32677523
http://dx.doi.org/10.1177/2192568220935813
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author Kitzen, Joep
Vercoulen, Timon F. G.
Schotanus, Martijn G. M.
van Kuijk, Sander M. J.
Kort, Nanne P.
van Rhijn, Lodewijk W.
Willems, Paul C. P. H.
author_facet Kitzen, Joep
Vercoulen, Timon F. G.
Schotanus, Martijn G. M.
van Kuijk, Sander M. J.
Kort, Nanne P.
van Rhijn, Lodewijk W.
Willems, Paul C. P. H.
author_sort Kitzen, Joep
collection PubMed
description STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Total disc replacement (TDR) has been introduced in order to preserve segmental motion and thus reduce adjacent segment disease (ASD) as seen after spinal fusion. However, it is uncertain whether these presumed beneficial effects remain. The aim of this study was to evaluate the long-term incidence of ASD and residual-mobility in relation to clinical outcome. METHODS: A total of 210 patients treated with lumbar TDR for degenerative disc disease were invited for follow-up. ASD was reported in case of severe degeneration in an adjacent disc at latest follow-up, or if an increase in disc degeneration was observed in these adjacent segments as compared to direct postoperative radiographs. Residual-mobility of the TDR was defined as a minimal rotation of 4.6° on flexion-extension radiographs. Patient-reported outcome measures were obtained. RESULTS: Fifty-seven patients (27.1%) were lost to follow-up. In 32 patients (15.3%) a revision by spinal fusion had been performed. In 20 patients this revision had occurred ≥5 years after TDR and were included. Consequently, 141 patients were available for analysis (mean follow-up of 16.7 years). Residual-mobility was noted in 38.0%. No significant associations were observed between residual-mobility and the occurrence of ASD, or with clinical outcome. In addition, ASD and clinical outcome were not related either. CONCLUSIONS: It appears that long-term preservation of motion after TDR is met for only a third of patients. However, residual-mobility is not associated with the occurrence of ASD, and both residual-mobility and ASD do not appear to be related to long-term clinical outcome.
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spelling pubmed-83510642021-08-13 Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement Kitzen, Joep Vercoulen, Timon F. G. Schotanus, Martijn G. M. van Kuijk, Sander M. J. Kort, Nanne P. van Rhijn, Lodewijk W. Willems, Paul C. P. H. Global Spine J Original Articles STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Total disc replacement (TDR) has been introduced in order to preserve segmental motion and thus reduce adjacent segment disease (ASD) as seen after spinal fusion. However, it is uncertain whether these presumed beneficial effects remain. The aim of this study was to evaluate the long-term incidence of ASD and residual-mobility in relation to clinical outcome. METHODS: A total of 210 patients treated with lumbar TDR for degenerative disc disease were invited for follow-up. ASD was reported in case of severe degeneration in an adjacent disc at latest follow-up, or if an increase in disc degeneration was observed in these adjacent segments as compared to direct postoperative radiographs. Residual-mobility of the TDR was defined as a minimal rotation of 4.6° on flexion-extension radiographs. Patient-reported outcome measures were obtained. RESULTS: Fifty-seven patients (27.1%) were lost to follow-up. In 32 patients (15.3%) a revision by spinal fusion had been performed. In 20 patients this revision had occurred ≥5 years after TDR and were included. Consequently, 141 patients were available for analysis (mean follow-up of 16.7 years). Residual-mobility was noted in 38.0%. No significant associations were observed between residual-mobility and the occurrence of ASD, or with clinical outcome. In addition, ASD and clinical outcome were not related either. CONCLUSIONS: It appears that long-term preservation of motion after TDR is met for only a third of patients. However, residual-mobility is not associated with the occurrence of ASD, and both residual-mobility and ASD do not appear to be related to long-term clinical outcome. SAGE Publications 2020-07-02 2021-09 /pmc/articles/PMC8351064/ /pubmed/32677523 http://dx.doi.org/10.1177/2192568220935813 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Kitzen, Joep
Vercoulen, Timon F. G.
Schotanus, Martijn G. M.
van Kuijk, Sander M. J.
Kort, Nanne P.
van Rhijn, Lodewijk W.
Willems, Paul C. P. H.
Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement
title Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement
title_full Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement
title_fullStr Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement
title_full_unstemmed Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement
title_short Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement
title_sort long-term residual-mobility and adjacent segment disease after total lumbar disc replacement
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351064/
https://www.ncbi.nlm.nih.gov/pubmed/32677523
http://dx.doi.org/10.1177/2192568220935813
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