Optimizing success with lumbar disc arthroplasty

Eur Spine J. 2014 Oct;23(10):2127-35. doi: 10.1007/s00586-014-3309-8. Epub 2014 Apr 26.


Purpose: This study aimed at determining the variables that may prove useful in predicting clinical outcomes following lumbar disc arthroplasty.

Methods: Pre- and post-operative imaging assessments were obtained for 99 single-level lumbar disc arthroplasty patients from a prospective IDE study. The assessments and patient demographics were tested to identify variables that were significantly associated with clinical outcomes.

Results: Clinical outcome data were available for 85 % of patients at the 5-year follow-up. Numerous assessments made from the pre-operative imaging were found to have statistically significant associations with clinical outcomes at 2 and 5 years. The most notable factors were related to the amount of degeneration at the index level, with patients achieving better outcome scores at 5 years if they have higher grades of degeneration preoperatively.

Conclusions: Several variables may prove effective at optimizing clinical outcomes including a preoperative disc height <8 mm, Modic type 2 changes adjacent to the target disc, a low amount of lordosis present at the treatment level, low levels of fatty replacement of the paraspinal musculature, a prominent amount of facet joint or disc degeneration, and the presence of flat or convex vertebral endplates. There were also post-operative findings associated with better patient outcomes including a larger percent of the endplate covered with the implant, larger implant heights, greater increases in disc space heights, and a larger increase in index level lumbar lordosis. These variables could be explored in other clinical studies to facilitate meta-analyses that could identify effective strategies to optimize clinical outcomes with lumbar disc arthroplasty.

Publication types

  • Clinical Trial
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arthrography / standards*
  • Female
  • Humans
  • Intervertebral Disc / diagnostic imaging
  • Intervertebral Disc / pathology
  • Intervertebral Disc / surgery*
  • Intervertebral Disc Degeneration* / diagnostic imaging
  • Intervertebral Disc Degeneration* / pathology
  • Intervertebral Disc Degeneration* / surgery
  • Logistic Models
  • Lordosis / diagnostic imaging
  • Lordosis / pathology
  • Lordosis / surgery
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery*
  • Magnetic Resonance Imaging / standards*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Sacrum / diagnostic imaging
  • Sacrum / pathology
  • Sacrum / surgery
  • Total Disc Replacement / methods*
  • Treatment Outcome
  • Young Adult
  • Zygapophyseal Joint / diagnostic imaging
  • Zygapophyseal Joint / pathology
  • Zygapophyseal Joint / surgery