Influence of positioning of L4–5 disc prostheses on functional outcomes and sagittal balance: 2-year follow-up of a cohort of 38 patients

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  • 1 Department of Orthopaedic and Traumatological Surgery, University of Paris–Sud;
  • 2 Department of Orthopaedic and Traumatological Surgery, University of Paris–Nord Val de Seine; and
  • 3 Department of Orthopaedic and Traumatological Surgery, University of Paris–Est Créteil, Paris, France
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OBJECTIVE

The main objective of this study was to evaluate the influence of L4–5 total disc replacement (TDR) positioning on functional outcome at the 2-year follow-up. The secondary objective was to assess its influence on sagittal balance.

METHODS

Prospective data were compiled for 38 single-level L4–5 ProDisc-O TDRs. Anteroposterior placement (APP) was the distance between the center of the implant and the center of the L5 endplate divided by the total length of the L5 endplate. This ratio was expressed as a percentage (APP 0%–49%, anterior off-centering; 50%, perfect centering; and 51%–100%, posterior off-centering). The patients were divided into 3 groups depending on the APP and using quartile values: group 1, anterior placement (APP 0%–46%); group 2, central placement (APP 46.1%–52%, the 2 central quartiles); and group 3, posterior placement (APP 52.1%–100%). The sagittal balance parameters assessed were overall lordosis, segmental lordosis, and pelvic incidence. Adequate lordosis was defined for each patient according to their pelvic incidence. The Oswestry Disability Index and visual analog scale (VAS) scores for back and leg pain were assessed.

RESULTS

The average APP was 48% (range 40%–64%). There were 10 patients in group 1, 18 in group 2, and 10 in group 3. There was a significant difference in functional outcomes among the 3 groups. APP influenced the VAS back (p = 0.04) and VAS leg (p = 0.05) scores. Group 1 consistently showed the highest performance scores. No significant association between APP and the sagittal balance parameters was found. Patients who had preoperative sagittal imbalance or those who significantly modified their balance after the surgery had the poorest outcomes.

CONCLUSIONS

Disc prostheses at L4–5 seem to provide better functional outcome when they are positioned anteriorly to the center of the vertebral body.

ABBREVIATIONS APP = anteroposterior placement; LL = lumbar lordosis; ODI = Oswestry Disability Index; PI = pelvic incidence; TDR = total disc replacement; VAS = visual analog scale.

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Contributor Notes

Correspondence Baptiste Boukebous: Beaujon-Bichat Hospital, University of Paris–Nord Val de Seine, Paris, France. baptiste.boukebous@aphp.fr.

INCLUDE WHEN CITING Published online February 21, 2020; DOI: 10.3171/2019.12.SPINE191117.

Disclosures Dr. Flouzat Lachaniette: consultant for Groupe Lepine and Biom’Up.

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