Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total disc arthroplasty by using the ProDisc prosthesis: a prospective study with 2-year minimum follow up

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Abstract
The authors conducted a prospective longitudinal study to assess the efficacy of ProDisc arthroplasty in patients in whom symptomatic adjacent-segment degeneration has developed after remote lumbar fusion. The follow-up period was a minimum of 2 years. The 20 patients in this study ranged in age from 18 to 67 years. They presented with disabling adjacent-level discogenic low-back pain with or without L1-S1 radicular pain. Patients with radiographic evidence of circumferential spinal stenosis or facet joint degeneration had been excluded. Patients were assessed preoperatively and postoperatively at 3, 6, 12, and 24 months. Eighteen patients (90%) fulfilled all follow-up criteria. The median age of all patients was 50 years. Statistical improvements in visual analog scale, Oswestry Disability Index, and patient satisfaction scores were documented 3 months after arthroplasty. These improvements remained at the 24-month follow-up examinations. Patient satisfaction rates were 86% at 24 months. Radicular pain was also significantly decreased. No additional surgeries were necessary at affected or unaffected levels. Analysis of early results indicates that ProDisc lumbar total disc arthroplasty is an efficacious treatment for symptomatic adjacent-segment lumbar discogenic low-back pain following remote fusion. Significant improvements in patient satisfaction and disability scores were observed by 3 months postoperatively and were maintained at the 2-year follow-up examination. No device-related complications occurred. Patients should be screened carefully for evidence of facet joint impingement/degeneration, hardware-induced pain, and/or nonunion at prior fusion levels before undergoing disc replacement surgery.