Patient-reported Outcomes and Revision Rates at a Mean Follow-up of 10 Years After Lumbar Total Disc Replacement

STUDY DESIGN.: Prospective observational cohort study. OBJECTIVE.: To determine the long-term clinical results and prosthesis survival in patients treated with lumbar total disc replacement (TDR). SUMMARY OF BACKGROUND DATA.: Fusion has become the current standard surgical treatment for lumbar degenerative disease. TDR is an alternative treatment that seeks to avoid fusion-related adverse events, specifically adjacent segment disease. METHODS.: Sixty-eight consecutive patients treated with TDR from 2003–2008 were invited to follow-up and complete a Visual Analog Scale (VAS) for back and leg pain, the Dallas Pain Questionnaire (DPQ) and the Short Form-36. These surveys were also administered to the subjects prior to their index TDRs. Data on re-operation were collected from the patients’ medical records. RESULTS.: Fifty-seven (84%) patients were available for follow-up at a mean 10.6 years post-operative(range, 8.1–12.6 years). There was a significant improvement from pre-op to latest follow-up in VAS (6.8 vs 3.2, p?<?0.000) and DPQ (63.2 vs 45.6, p?=?0.000) in the entire cohort. Nineteen patients (33%) had a revision fusion surgery after their index TDR. Patients who had a revision surgery and statistically significant worse outcome scores at last follow-up compared to patients who had no revision. Thirty patients (52.6%) would choose the same treatment again if they were faced with the same problem. CONCLUSION.: This study demonstrated significant improvement in long-term clinical outcomes, similar to previously published studies, and 2/3 of the discus prostheses were still functioning at follow-up. However, there is still a lack of well-designed long-term studies, thus requiring further investigation.Level of Evidence: 3