A novel surgical treatment of lumbar disc herniation in patients with long-standing degenerative disc disease

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Object. In patients with long-standing lumbar degenerative disc disease (DDD) conventional surgical therapy of a herniated disc may worsen back pain due to further destabilization of the affected motion segment. In recent years, total-disc arthroplasty has been introduced to treat DDD while maintaining segmental mobility. To the best of the authors' knowledge, this is the first report involving lumbar disc herniation and long-standing DDD submitted to combined anterior microdiscectomy with sequestrectomy and total-disc arthroplasty.

Methods. Fourteen patients with long-standing DDD and a recently herniated disc underwent total anterior lumbar microdiscectomy, with removal of the herniated disc, and total-disc arthroplasty. There were nine women and five men whose mean age was 39.6 years (range 22–56 years) in whom back and leg pain had been present for a mean of 75.4 (range 9–360) and 9.4 (range 0.33–36) months, respectively. Thirteen patients underwent L5—S1 and one underwent L4–5 surgery. In all cases the procedure and the postoperative courses were uneventful. After a mean follow-up period of 12.5 months (range 3.9–21.1 months), outcome was excellent in 11 and good in three patients.

Conclusions. The aforementioned surgical treatment of a recently herniated lumbar disc in patients with long-standing DDD yielded very favorable early results.

Article Information

Address reprint requests to: Thomas-Marc Markwalder, M.D., Neurochirurg FMH, Thunstrasse 160, CH-3074 Bern-Muri, Switzerland. email: thomasmarc.markwalder@bluewin.ch.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 4. Left: Sagittal T2-weighted MR image of the lumbar spine. There is significant herniation of the L5—S1 disc, reduced intervertebral distance, a “black disc” appearance because of dehydration and Modic sign because of long-standing dysfunction of the motion segment. Right: Axial T2-weighted MR image revealing the L5—S1 disc herniation with right-sided nerve root compression.

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    Case 4. Left: Sagittal myelogram obtained after L5—S1 total disc arthroplasty. There is no compression of nerve roots or the thecal sac. The ProDisc prosthesis is correctly positioned and provides physiological intervertebral height and segmental lordosis. Right: Axial CT scan obtained after myelography. There are considerable artifacts because of the implant. Nevertheless, the thecal sac is depicted without neurocompression. Based on the two images, we believed that the offending disc tissue has been completely removed from the spinal canal.

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