The influence of total disc arthroplasty with Mobidisc prosthesis on lumbar spine and pelvic parameters: a prospective in vivo biomechanical study with a minimum 3 year of follow-up.

Autor: Smajic S; Department of Orthopedic, Trauma and Spine Surgery, St. Josef Hospital, Linnich, Germany., Vujadinovic A; Department of Orthopedic and Trauma Surgery, Tuzla University Hospital, Tuzla, Bosnia and Herzegovina.; Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.; Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University of Dammam, Dammam, Kingdom of Saudi Arabia., Kasapovic A; Department of Orthopedic and Trauma Surgery, University Hospital of Bonn, Bonn, Germany., Aldakheel DA; Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.; Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University of Dammam, Dammam, Kingdom of Saudi Arabia., Charles YP; Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France., Walter A; Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France., Steib JP; Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France., Maffulli N; Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.; Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB, England, UK.; Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England, UK., Migliorini F; Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.; Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany. migliorini.md@gmail.com., Baroncini A; Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
Jazyk: angličtina
Zdroj: Journal of orthopaedic surgery and research [J Orthop Surg Res] 2022 Oct 15; Vol. 17 (1), pp. 456. Date of Electronic Publication: 2022 Oct 15.
DOI: 10.1186/s13018-022-03352-6
Abstrakt: Background: This study examined the impact of Mobidisc implant on spinopelvic parameters, with particular focus on the preservation of the lumbar lordosis (LL) and on the segmental lordosis (SL) of the treated and adjacent segments.
Methods: A prospective study was conducted on 63 consecutive patients with symptomatic degenerative disc disease who underwent Mobidisc implantation at the Clinic for Spinal Diseases in Strasbourg, France. Based on the profile images of the whole, the following static spinopelvic parameters were measured and analysed: lumbar lordosis L1-S1 (LL), SL for L3-L4, L4-L5 and L5-S1, sacral slope (SS), pelvic tilt (PT) and pelvic incidence. In the lumbar spine images, the anterior (ADH) and posterior disc height (PDH) were measured prior to surgery and at the different follow-up appointments. The preoperative and postoperative values were compared and statistically analysed at different time intervals.
Results: Sixty-three patients were included in the study. The average age of the patients was 41.4 years (range 27-59 years). The mean follow-up was 44 months (range 36-71 months). Overall, total disc replacement (TDR) led to an increase in LL which increased TED over time. The preoperative LL measured 48.9° ± 10.1° and 53.4° ± 9.9° at 3 years follow-up (p < 0.0001). In the cohort of patients who underwent TDR at L4-5, the LL increased from 51.6° ± 10° to 56.2° ± 9.2° at the last FU (p = 0.006). All other spinopelvic parameters remained stable between the preoperative values and the last follow-up. In the patients who underwent L5-S1 TDR, a significant increase in LL was also observed between preoperative data and at the last FU (from 47.8° ± 10.1° to 53.3° ± 10.1°, p < 0.0001). Following L5-S1 TDR, the SS increased from 32.9° ± 8.3° to 35.6° ± 7.4° (p = 0.05) and the PT decreased from 15.4° ± 6.2° to 11.6° ± 5.7° between preoperative values and the last follow-up. Considering the entire cohort, the SL L5-S1 increased significantly from 5.9° ± 4.2° preoperatively to 8.1° ± 4.4° (p < 0.01) at the last FU, while at the L4-L5 level, the SL remained stable from 9.9 ± 4.5° to 10.7° ± 3.8° (p = 0.3). After L4-5 TDR, an increase in ADH and PDH at the treated level was observed, while these parameters progressively decreased in the adjacent segment. In patients who underwent L5-S1 TDR, a significant increase in L5-S1 ADH and PDH was observed from 18.8 ± 9.1 to 28.4 ± 11.1 and from 9.5 ± 3.8 to 17.6 ± 9.5 pixels, respectively. ADH and PDH at the proximal adjacent levels L3-4 and L4-5 were reduced. We did not observe any case of implant failure or damage to the bone/implant interface.
Conclusion: TDR with Mobidisc allows for an improvement of LL and SL at the treated level. An increase in both anterior and posterior disc height was observed at the treated level. While disc height decreased at the adjacent level, further studies are required to investigate whether these changes are clinically relevant.
(© 2022. The Author(s).)
Databáze: MEDLINE
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