Segmental mobility, disc height and patient-reported outcomes after surgery for degenerative disc disease: a prospective randomised trial comparing disc replacement and multidisciplinary rehabilitation

• Published in: The bone & joint journal Vol. 95-B; no. 1; pp. 81 - 89
• Main Authors: Johnsen, L G, Brinckmann, P, Hellum, C, Rossvoll, I, Leivseth, G
• Format: Journal Article
• Language: English
• Published: England 01.01.2013
• Subjects: Adult; Biomechanical Phenomena; Female; Follow-Up Studies; Humans; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - physiopathology; Intervertebral Disc - surgery; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Degeneration - rehabilitation; Intervertebral Disc Degeneration - surgery; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - physiopathology; Lumbar Vertebrae - surgery; Lumbosacral Region; Male; Middle Aged; Prospective Studies; Radiostereometric Analysis; Range of Motion, Articular; Self Report; Total Disc Replacement; Treatment Outcome
• ISSN: 2049-4394; 2049-4408
• DOI: 10.1302/0301-620X.95B1.29829

This prospective multicentre study was undertaken to determine segmental movement, disc height and sagittal alignment after total disc replacement (TDR) in the lumbosacral spine and to assess the correlation of biomechanical properties to clinical outcomes.A total of 173 patients with degenerative disc disease and low back pain for more than one year were randomised to receive either TDR or multidisciplinary rehabilitation (MDR). Segmental movement in the sagittal plane and disc height were measured using distortion compensated roentgen analysis (DCRA) comparing radiographs in active flexion and extension. Correlation analysis between the range of movement or disc height and patient-reported outcomes was performed in both groups. After two years, no significant change in movement in the sagittal plane was found in segments with TDR or between the two treatment groups. It remained the same or increased slightly in untreated segments in the TDR group and in this group there was a significant increase in disc height in the operated segments. There was no correlation between segmental movement or disc height and patient-reported outcomes in either group.In this study, insertion of an intervertebral disc prosthesis TDR did not increase movement in the sagittal plane and segmental movement did not correlate with patient-reported outcomes. This suggests that in the lumbar spine the movement preserving properties of TDR are not major determinants of clinical outcomes.