Total Disc Replacement Viable Alternative to Arthrodesis

Improved pain and function after disc arthroplasty for two-level degenerative disc disease

MONDAY, May 2 (HealthDay News) -- Lumbar total disc arthroplasty is a viable alternative to arthrodesis for the treatment of two-level degenerative disc disease, according to a study published in the April 20 issue of The Journal of Bone & Joint Surgery.

Rick Delamarter, M.D., from the Spine Institute at Saint John's Health Center in Santa Monica, Calif., and colleagues assessed the 24-month results of a trial comparing total disc replacement in 148 patients with that of arthrodesis in 67 patients with degenerative disc disease at two levels from L3 to S1. Participants were evaluated pre- and postoperatively though self-assessments and by physical, neurological, and radiographic examinations.

The investigators found that, at 24 months, statistical success was seen in 58.8 and 47.8 percent of patients in the disc replacement and arthrodesis group, respectively, thereby demonstrating noninferiority. The mean Oswestry Disability Index improved significantly in both groups, but the mean percentage improvement and percentage of patients who had an increase of 15 points or more was higher in the disc replacement group. At 24 months, the disc replacement group had significantly better Short Form-36 physical component scores, visual analog scale scores (from three to 24 months), and reduction in narcotic usage, and had lumbar spinal motion range on radiographs averaging 7.8 and 6.2 degrees at the superior and inferior disc, respectively. Most patients said they would undergo the same surgery again (78.2 percent of disc replacement and 62.1 percent of arthrodesis group).

"Two-level lumbar disc arthroplasty is an alternative to and offers clinical advantages in terms of pain relief and functional recovery in comparison with arthrodesis," the authors write.

Several authors disclosed financial relationships with Synthes Spine and Spine Solutions. The study was funded by Synthes USA Products LLC, the manufacturer of the ProDisc-L.

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