Lumbar disc arthroplasty: indications, biomechanics, types, and radiological criteria

• Published in: Radiologe Vol. 46; no. 9; pp. 768, 770 - 768
• Main Authors: Baur-Melnyk, A, Birkenmaier, C, Reiser, M F
• Format: Journal Article
• Language: German
• Published: Germany 01.09.2006
• Subjects: Adult; Aged; Biomechanical Phenomena; Female; Follow-Up Studies; Humans; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - physiopathology; Intervertebral Disc - surgery; Joint Prosthesis; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - physiopathology; Lumbar Vertebrae - surgery; Male; Middle Aged; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Prosthesis Design; Prosthesis Failure; Radiography; Reoperation; Spinal Fusion; Spinal Osteophytosis - diagnostic imaging; Spinal Osteophytosis - physiopathology; Spinal Osteophytosis - surgery
• ISSN: 0033-832X
• DOI: 10.1007/s00117-006-1356-9

Lumbar total disc replacement (TDR) was developed to treat a painful degenerative lumbar motion segment while avoiding the disadvantages of fusion surgery, such as adjacent segment instabilities. Early clinical results with TDR have shown a significant reduction in low back pain and a significant improvement in disability scores. When compared to fusion, the results with TDR tend to be superior in the short-term follow-up and initial rehabilitation is faster. The radiological assessment is an integral part of the preoperative work-up. Plain X-rays of the lumbar spine should be complemented by flexion - extension views in order to assess residual segmental mobility. Computed tomography is used to exclude osteoarthritis of the zygapophyseal joints, Baastrup's disease (kissing spines) and other sources of low back pain. Magnetic resonance imaging is useful to exclude substantial disc protrusions; it allows for the detection of disc dehydration and bone marrow edema in the case of activated spondylochondrosis. If osteoporosis is suspected, an osteodensitometry of the lumbar spine should be performed. Postoperative plain X-rays should include antero-posterior and lateral views as well as flexion - extension views in the later postoperative course. Measurements should determine the disc space height in the lateral view, the segmental and total lumbar lordosis as well as the segmental mobility in the flexion - extension views. The ideal position of a TDR is exactly central in the ap-view and close to the dorsal border of the vertebral endplates in the lateral view. Malpositioning may cause segmental hyperlordosis and unbalanced loading of the endplates with the risk of implant subsidence and migration.