In which cases do surgeons specializing in total disc replacement perform fusion in patients with symptomatic lumbar disc degeneration?

Autor: Zigler JE; Center for Disc Replacement at Texas Back Institute, 2060 W. Parker Rd. #200, Plano, TX, USA. jzigler@texasback.com., Guyer RD; Center for Disc Replacement at Texas Back Institute, 2060 W. Parker Rd. #200, Plano, TX, USA., Blumenthal SL; Center for Disc Replacement at Texas Back Institute, 2060 W. Parker Rd. #200, Plano, TX, USA., Satin AM; Texas Back Institute, Plano, TX, USA., Shellock JL; Center for Disc Replacement at Texas Back Institute, 2060 W. Parker Rd. #200, Plano, TX, USA., Ohnmeiss DD; Center for Disc Replacement at Texas Back Institute, 2060 W. Parker Rd. #200, Plano, TX, USA.; Texas Back Institute Research Foundation, Plano, TX, USA.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2022 Oct; Vol. 31 (10), pp. 2607-2611. Date of Electronic Publication: 2022 Aug 04.
DOI: 10.1007/s00586-022-07282-z
Abstrakt: Purpose: The purpose of this study was to investigate reasons and their frequency for why spine surgeons subspecializing in total disc replacement (TDR) performed lumbar fusion rather than TDR.
Methods: The study was based on a consecutive series of 515 patients undergoing lumbar TDR or fusion during a 5-year period by three surgeons specializing in TDR. For each fusion patient, the reason for not performing TDR was recorded.
Results: TDR was performed in 65.4% (n = 337) of patients and the remaining 34.6% (n = 178) underwent anterior lumbar interbody fusion (ALIF ± posterior instrumentation). Of the 178 fusion patients, the most common reason for fusion was combined factors related to severe degenerative changes (n = 59, 11.5% of the study population). The second most common reason was > Grade 1 spondylolisthesis (n = 32, 6.2%), followed by insurance non-coverage (n = 24, 4.7%), and osteopenia/osteoporosis (n = 13, 2.5%). Fusion patients were significantly older than TDR patients (52.5 vs. 41.6 years; p < 0.01). There was no significant difference with respect to gender (41.2% female vs. 43.8% female, p > 0.05) or the percentage of patients with single-level surgery (61.2% vs. 56.7%, p > 0.05).
Conclusion: The most common reason for not performing lumbar TDR was related to anatomic factors that may compromise stability of the operated segment and/or TDR functionality. The older age of fusion patients may be related to these factors. This study found that many patients are appropriate candidates for lumbar TDR. However, even among TDR subspecialists, fusion is preferred when there are factors that cannot be addressed with TDR and/or may compromise implant functionality.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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