Article

INTRODUCTION: It has been suggested that the indication for lumbar total disc
replacement (LTDR) takes into account the local parameters, such as the type of
disc disease demonstrated on MRI and the presence or absence of facet joint
osteoarthritis. The type of preoperative sagittal curvature could also be taken
into account. This study reports the clinical results of LTDRs depending on the
type of sagittal spinal alignment. MATERIAL AND METHODS : Eighty patients were
included in this prospective study, with a mean age of 41.7years (range,
27-56years). The clinical analysis took into account the lumbar VAS, the Oswestry
Disability Index (ODI), and the preoperative frequency of painkiller use, at
1year and at the last follow-up. The satisfaction index, return to work, and
willingness to undergo the same treatment were also collected. The radiological
study included the analysis of lumbar-pelvic parameters to distribute the
patients according to the Roussouly classification. RESULTS: The mean follow-up
was 59.1months (range, 14-96months). The type 1 group included four cases.
Reduction of the VAS, the ODI score, and the frequency of painkiller use at the
last follow-up were significant in type 2 and 3 patients, and non-significant for
type 4. Eighty-five percent of type 2 patients and 87.5% of type 3 patients were
satisfied or very satisfied with the surgery versus only 68% of the type 4
patients. In addition, 63% of the type 4 patients declared they would be willing
to undergo the same treatment again versus 85% of the type 2 patients and 82.5%
of the type 3 patients. It should also be noted that 67% of the patients in this
series returned to work. DISCUSSION AND CONCLUSION: This study underscores the
influence of the type of sagittal curvature on the clinical results of LTDR, with
type 4 patients showing inferior clinical results because of a higher rate of
residual lower back pain.
The indication in LTDR should be reconsidered for
discogenic lower back pain in type 4 patients.
CI - Copyright (c) 2016 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS