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Total Disc Replacement In Postdiscectomy Patients Versus Patients with No Previous Lumbar Surgery

The authors of the study wanted to compare the results of total disc replacement, TDR, in subjects who had previous discectomy to those who had not had previous surgery. Typically, TDR has been reserved for patients with disc degeneration, disc herniation, and radicular pain and no previous surgery Some have feared that during discectomy, removal of the posterior portion of the spine when decompressing neural structures could destabilize the area, making future disc replacement impossible.

Herniated discs have been treated successfully with discectomy. This means that a portion of the disc is removed when herniated. However, the positive benefits can be lost over time. Failure after discectomy has been reported as high as 37 percent. Thirteen to twenty-five percent of patients require additional surgery within ten years. Disabling pain from the disc after discectomy has been treated successfully with spinal fusion. However, limiting movement of the spinal column as a result of spinal fusion can be problematic. Abnormal stress above and below the site of fusion has been shown to cause accelerated deterioration of these segments. This can then result in the need for additional fusion surgery.

Total disc replacement is different from fusion because it is designed to preserve motion at the spinal level. Maintaining motion has shown to improve outcomes of surgery for disc degeneration and disc herniation. Instead of having fusion following failed discectomy, the authors felt that TDR would be a viable option. This may also eliminate the problems associated with accelerated deterioration of segments above and below a fusion.

Twenty patients with previous discectomy, and 67 patients with no previous spine surgery were selected for the study. Outcomes were compared using several methods. Visual analog scale for pain rating from zero to ten was used A modified Oswestry questionnaire was used to evaluate perceived function. Subjects were also asked if they would have the same procedure again. Data was collected before surgery, at 6 weeks, and at three, six, 12, 18, and 24 months after surgery.

The results showed that at no time during the study there was a statistically significant difference between the two groups. The percentage of patients indicating that they would have the same surgery again was greater than 80 percent in both groups at all follow up periods.

The authors suggest that patients who have previously undergone a discectomy do well with TDR. Their clinical results are similar to those having had DTR with no prior discectomy surgery. TDR may be a reasonable surgical option in lieu of fusion in postdiscectomy patients who have developed discogenic pain at the involved level.

M. Leahy et al. Comparison of results of total disc replacement in postdiscectomy patients versus patients with no previous lumbar surgery.SPINE. July 2008. Volume 33, Number 15. Pp. 1690-1693.


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