Rick B. Delamarter, MD
Arthrodesis has been utilized for the treatment of lumbar degenerative disc disease in patients who have had unsuccessful nonoperative care. Arthrodesis alters the biomechanics of the spine as motion is lost at the fused level(s), and the overall sagittal alignment may shift. These changes in biomechanics generally become more pronounced as the number of fused vertebral levels increases and may exert excessive forces at adjacent vertebral levels.
Total disc arthroplasty has been developed and used clinically to maintain motion and to reduce the biomechanical changes associated with arthrodesis. Previous randomized clinical trials of lumbar disc arthroplasty treatment at a single level demonstrated results that were equivalent or superior to those of lumbar interbody arthrodesis at two years of follow-up. Longer-term follow-up of these trials has shown that these outcomes have been maintained.
Two-level lumbar total disc arthroplasty has been described in the literature. In the corresponding article to this JBJS video supplement, the authors present twenty-four-month results of a prospective, randomized, controlled, multicenter clinical trial comparing lumbar total disc arthroplasty with arthrodesis for the treatment of two-level degenerative disc disease. Their preliminary conclusion is that the ProDisc-L total disc replacement offers advantages over arthrodesis in terms of pain relief and functional recovery.
See the Corresponding JBJS Article:
- Rick Delamarter, MD, Jack E. Zigler, MD, Richard A. Balderston, MD, Frank P. Cammisa, MD, Jeffrey A. Goldstein, MD, Jeffrey M. Spivak, MD
- Prospective, Randomized, Multicenter Food and Drug Administration Investigational Device Exemption Study of the ProDisc-L Total Disc Replacement Compared with Circumferential Arthrodesis for the Treatment of Two-Level Lumbar Degenerative Disc Disease: Results at Twenty-four Months
J Bone Joint Surg Am. 2011; 93:705-715 doi:10.21 [Article]
- Total Run Time: 26:52 minutes
- Catalog Number: 8028
- VJO Publication Date: April, 2011