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Intervertebral Disc Degeneration in Clinics
Published in Raquel M. Gonçalves, Mário Adolfo Barbosa, Gene and Cell Delivery for Intervertebral Disc Degeneration, 2018
Pedro Santos Silva, Paulo Pereira, Rui Vaz
Lumbar arthroplasty or total disc replacement was developed as a motion-preserving technique to lower the rate of adjacent segment disease, while keeping the rationale of lumbar fusion of removing the pain generator. There are various devices in the market, all of them including articular surfaces that tolerate loading and conserve the range of motion. Typically, they are inserted through an anterior approach. Most authors agree that adequate selection is the most important factor affecting arthroplasty outcomes and that ideal candidates are young patients with relatively preserved disc height, without any significant deformity, instability, or facet degeneration; in these patients, total disc replacement can be a suitable alternative to lumbar fusion (Salzmann et al. 2017). A review of five meta-analysis, about lumbar arthroplasty versus fusion, concludes that lumbar total disc replacement may be an effective technique for the treatment of selected patients with lumbar DDD, with at least equivalent results to lumbar fusion in the short-term; however, long-term studies are needed to address clinical outcomes, complications, and adjacent segment disease rates (Ding et al. 2017).
The spine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Patients present with neck and arm pain (brachalgia), paraes- thesia and motor weakness in the distribution of the compromised nerve root (radiculopathy). This may be caused by disc herniation or degenerative stenosis. Symptoms often respond to conservative treatment including physiotherapy and medication for neuropathic pain (amitriptyline, gabapentin or pregabalin) or CT-guided foraminal epidural steroid injections of local anaesthetic and steroid. Intractable pain and/ or functional neurological deficit are indications for surgical intervention. Surgical options include anterior cervical discectomy and fusion (using a cage packed with bone graft and plate), cervical total disc replacement (Figure33.2) or posterior laminoforaminotomy. Randomised controlled trials have compared anterior cervical discectomy and fusion to cervical disc replacement. Similar clinical outcomes have been observed in both groups. However, cervical disc replacements preserve motion in the operated level, and may protect against adjacent segment disease in the longer term.
Minimally Invasive Total Disc Replacement and Facet Joint Replacement
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
D. Greg Anderson, Chadi Tannoury
Little has been published regarding the outcomes of minimally invasive total disc replacement procedures. In 1997, Mayer and Wiechert described a minimally invasive surgical approach to the anterior lumbar spine (29). In 2002, Mayer et al. reported using the minimally invasive anterior lumbar approach to implant series of artificial disc prostheses in the lumbar spine and noted satisfactory results in approximately 80% of the patients in the series. Complications occurred in 8.8% (three patients) of the patients but resolved in two or three patients (19).
Predictive factors for return to work after lumbar discectomy
Published in International Journal of Occupational Safety and Ergonomics, 2021
Maryam Atarod, Elham Mirzamohammadi, Hasan Ghandehari, Ramin Mehrdad, Nazanin Izadi
The most common indication for spinal surgery is neurological compression that may be due to two common etiologies including prolapsed intervertebral disc (PID) and spinal stenosis. The prolapsed cases are asymptomatic in 20–30% of patients and may be seen only by magnetic resonance imaging (MRI). The highest prevalence of disk herniation is among people aged 30–50 years, with a male to female ratio of 2:1 [6]. Relatively, 50–70% of LBP patients would improve spontaneously or with conservative treatment and would return to work during 4 weeks [1,2]. In cases with recalcitrant pain during 6 weeks, physiotherapy is recommended [7]. Surgery is indicated if neurological symptoms develop. The mean time for return to work is 1.7 weeks and 25% would return to work after this time [1]. Ninety-seven percent would return to work after 8 weeks. The gold standard surgery for LBP to control the chronic disabling pain is spinal fusion. Complete fusion repair is usually delayed until 3 months. Total disc replacement is another method with similar indications that is preferred to fusion from the aspects of immediate stability and preservation of motion.
Immunobiology of periprosthetic inflammation and pain following ultra-high-molecular-weight-polyethylene wear debris in the lumbar spine
Published in Expert Review of Clinical Immunology, 2018
John H. Werner, John H. Rosenberg, Kristen L. Keeley, Devendra K. Agrawal
The most common indications for total disc replacement are to maintain spine mobility and mitigate pain [84]. In addition to immunologic stimulus for pain, different biomechanical loading patterns following a lumbar total disc replacement may also contribute to persistent pain [81]. Pain patterns, described by Siepe [84], begin with lumbar facet or sacroiliac pain, and are the most common reason for unsatisfactory results following disc replacement surgery [84]. Patients with early onset pain (less than 6 months following procedure) have a significantly higher risk of developing persistent problems. Suboptimal outcomes and higher incidences of posterior joint pain were observed for arthroplasties at the L5-S1 level, and combined arthroplasty of the L4-L5 and L5-S1 levels [84]. The manner in which the prosthesis bears forces could have potential effects on pain. Fixed-bearing devises showed increased vascularization in tissues with wear and necrosis than in tissues without wear. Comparatively, mobile bearing lumbar total disc replacements demonstrated low-to-moderate vascularization and necrosis [78]. Loading analysis following total disc replacements demonstrated increased facet loading and decreased motion compared to adjacent spinal segments due to disruption of stabilizing ligaments during surgery [81]. Pain refractory to conventional treatment such as injection and physical therapy, may be treated with spinal cord stimulation to achieve better outcomes [81].
The Mobi-C® cervical disc and other devices for two-level disc replacement: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2019
Siddharth A. Badve, Swamy Kurra, Pierce D. Nunley, William F. Lavelle
Jackson et al. evaluated subsequent surgery rates in patients treated with Mobi-C® total disc replacement or ACDF up to five years. There were 339 patients in the 2-level study (234 patients with Mobi-C® and 105 patients with ACDF). At five years, they found that the surgical intervention rate was significantly higher in ACDF patients (21%) compared to Mobi-C® patients (7.3%). The Mobi C® patients also demonstrated fewer index and adjacent level subsequent surgeries [44].