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

Restricted access

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

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.
Article Information

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.
Headings
References
  • 1

    Boss OLTomasi SOBäurle BSgier FHausmann ON: Lumbar total disc replacement: correlation of clinical outcome and radiological parameters. Acta Neurochir (Wien) 155:192319302013

    • Search Google Scholar
    • Export Citation
  • 2

    Cakir BSchmidt RHuch KPuhl WRichter M: [Sagittal alignment and segmental range of motion after total disc replacement of the lumbar spine.] Z Orthop Ihre Grenzgeb 142:1591652004 (German)

    • Search Google Scholar
    • Export Citation
  • 3

    Cinotti GDavid TPostacchini F: Results of disc prosthesis after a minimum follow-up period of 2 years. Spine (Phila Pa 1976) 21:99510001996

    • Search Google Scholar
    • Export Citation
  • 4

    Fairbank JCCouper JDavies JBO’Brien JP: The Oswestry low back pain disability questionnaire. Physiotherapy 66:2712731980

  • 5

    Faure AKhalifé MThiebaut BRoubineau FFlouzat Lachaniette CHDubory A: Influence of the initial sagittal lumbar alignment on clinical and radiological outcomes of single-level lumbar total disc replacements at a minimum 2-year follow-up. Spine (Phila Pa 1976) 43:E959E9672018

    • Search Google Scholar
    • Export Citation
  • 6

    Gaffey JLGhanayem AJVoronov MLHavey RMCarandang GAbjornson C: Effect of increasing implant height on lumbar spine kinematics and foraminal size using the ProDisc-L prosthesis. Spine (Phila Pa 1976) 35:177717822010

    • Search Google Scholar
    • Export Citation
  • 7

    Groupe Technique National de Definition des Objectifs: Rapport du GTNDO: Analyse des Connaissances Disponibles sur des Problèmes de Santé Sélectionnés Leurs Déterminants et les Stratégies de Santé Publique: Définition d’Objectifs. Paris: La Documentation Française2003 (http://www.ladocumentationfrancaise.fr/var/storage/rapports-publics/034000115.pdf) [Accessed December 31 2019]

    • Search Google Scholar
    • Export Citation
  • 8

    Guyer RDMcAfee PCHochschuler SHBlumenthal SLFedder ILOhnmeiss DD: Prospective randomized study of the Charite artificial disc: data from two investigational centers. Spine J 4 (6 Suppl):252S259S2004

    • Search Google Scholar
    • Export Citation
  • 9

    Jaumard NVWelch WCWinkelstein BA: Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 133:0710102011

    • Search Google Scholar
    • Export Citation
  • 10

    Jones CWSmitham PWalsh WR: Relationship of surgical accuracy and clinical outcomes in Charitè lumbar disc replacement. Orthop Surg 4:1451552012

    • Search Google Scholar
    • Export Citation
  • 11

    Käfer WClessienne CBDäxle MKocak TReichel HCakir B: Posterior component impingement after lumbar total disc replacement: a radiographic analysis of 66 ProDisc-L prostheses in 56 patients. Spine (Phila Pa 1976) 33:244424492008

    • Search Google Scholar
    • Export Citation
  • 12

    Katsimihas MBailey CSIssa KFleming JRosas-Arellano PBailey SI: Prospective clinical and radiographic results of CHARITÉ III artificial total disc arthroplasty at 2- to 7-year follow-up: a Canadian experience. Can J Surg 53:40841452010

    • Search Google Scholar
    • Export Citation
  • 13

    Kim DHRyu KSKim MKPark CK: Factors influencing segmental range of motion after lumbar total disc replacement using the ProDisc II prosthesis. J Neurosurg Spine 7:1311382007

    • Search Google Scholar
    • Export Citation
  • 14

    Lazennec JYEven JSkalli WRakover JPBrusson ARousseau MA: Clinical outcomes, radiologic kinematics, and effects on sagittal balance of the 6 df LP-ESP lumbar disc prosthesis. Spine J 14:191419202014

    • Search Google Scholar
    • Export Citation
  • 15

    Le Huec JBasso YMathews HMehbod AAunoble SFriesem T: The effect of single-level, total disc arthroplasty on sagittal balance parameters: a prospective study. Eur Spine J 14:4804862005

    • Search Google Scholar
    • Export Citation
  • 16

    Le Huec JCMathews HBasso YAunoble SHoste DBley B: Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up. Orthop Clin North Am 36:3153222005

    • Search Google Scholar
    • Export Citation
  • 17

    Lemaire JPCarrier HSariali HSkalli WLavaste F: Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech 18:3533592005 (Erratum in J Spinal Disord Tech 19:76 2006)

    • Search Google Scholar
    • Export Citation
  • 18

    Liu JEbraheim NAHaman SPShafiq QKarkare NBiyani A: Effect of the increase in the height of lumbar disc space on facet joint articulation area in sagittal plane. Spine (Phila Pa 1976) 31:E198E2022006

    • Search Google Scholar
    • Export Citation
  • 19

    Liu YCXia QZhang JDXu BSHu YCJi N: [Effect of intervertebral position on range of motion after artificial lumbar total disc replacement and clinical management.] Zhonghua Yi Xue Za Zhi 90:275027542010 (Chinese)

    • Search Google Scholar
    • Export Citation
  • 20

    McAfee PCCunningham BHolsapple GAdams KBlumenthal SGuyer RD: A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. Spine (Phila Pa 1976) 30:1576–1583E388E3902005

    • Search Google Scholar
    • Export Citation
  • 21

    Patel VVAndrews CPradhan BBBae HWKanim LEAKropf MA: Computed tomography assessment of the accuracy of in vivo placement of artificial discs in the lumbar spine including radiographic and clinical consequences. Spine (Phila Pa 1976) 31:9489532006

    • Search Google Scholar
    • Export Citation
  • 22

    Ruiz FKBohl DDWebb MLRusso GSGrauer JN: Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale. Spine J 14:186018652014

    • Search Google Scholar
    • Export Citation
  • 23

    Rundell SADay JSIsaza JGuillory SKurtz SM: Lumbar total disc replacement impingement sensitivity to disc height distraction, spinal sagittal orientation, implant position, and implant lordosis. Spine (Phila Pa 1976) 37:E590E5982012

    • Search Google Scholar
    • Export Citation
  • 24

    Schmidt RObertacke UNothwang JUlrich CNowicki JReichel H: The impact of implantation technique on frontal and sagittal alignment in total lumbar disc replacement: a comparison of anterior versus oblique implantation. Eur Spine J 19:153415392010

    • Search Google Scholar
    • Export Citation
  • 25

    Tournier CAunoble SLe Huec JCLemaire JPTropiano PLafage V: Total disc arthroplasty: consequences for sagittal balance and lumbar spine movement. Eur Spine J 16:4114212007

    • Search Google Scholar
    • Export Citation
  • 26

    Tropiano PHuang RCLouis CAPoitout DGLouis RP: Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine (Phila Pa 1976) 28:245924652003

    • Search Google Scholar
    • Export Citation
  • 27

    Zindrick MRTzermiadianos MNVoronov LILorenz MHadjipavlou A: An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. Spine (Phila Pa 1976) 33:126212692008

    • Search Google Scholar
    • Export Citation
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 494 494 70
Full Text Views 38 38 10
PDF Downloads 38 38 2
EPUB Downloads 0 0 0
PubMed
Google Scholar