Hendrik Schmidt, Marcel Dreischarf, Patrick Strube and Michael Putzier
Total disc replacement has been developed as an alternative to fusion. However, several factors are associated with an inferior clinical mid-term outcome. There is a need for simple but well-defined preoperative factors, which have a predictive value and facilitate patient selection for lumbosacral total disc replacement (TDR). Therefore, in the present study we investigated preoperative radiological parameters to serve as predictors for the clinical outcome after TDR at the lumbosacral junction.
A total of 34 patients (16 females, 18 males) with the primary diagnosis of lumbosacral degenerative disc diseases who underwent TDR between 08/2005 and 12/2010 were evaluated in a clinical examination (Oswestry Disability Questionnaire (ODI) and visual analog scale (VAS) for overall, back, and leg pain) after a mean follow-up of 59.5 (24–87) months. A correlation analysis was performed between preoperative radiological parameters (segmental lordosis (SL), mean disc height (meanDH), anterior (aDH), middle (mDH), and posterior disc height (pDH) as well as geometrical relationships of these parameters: nA Index=aDH/meanDH, nP-Index=pDH/meanDH, AP-Index=aDH/ pDH, and nAP Index=aDH/pDH/meanDH) and clinical pain scales (ODI, VAS) at follow-up.
Particularly the relationships nA-Index, AP-Index, and nAP-Index were found to be strongly negatively correlated to the clinical outcome. Weaker correlation was found between: ODI and aDH, nA-Index, AP-Index (negative), and nP-Index (positive); VAS overall and SL, nP Index, mDH, and pDH (positive); and VAS back and nP-Index, and pDH (positive).
The preoperative normalized anterior-disc-height-index (nA Index) and the normalized anterior-posterior-discheight- index (nAP-Index) can serve as prognostic radiographic parameters before patients undergo lumbosacral TDR.
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