Total Lumbar Disc Replacement Success Associated with Lumbar Motion Segment
Many people with lower back pain undergo a surgery called a fusion, now considered the gold standard for treatment of certain back injuries. But, researchers still don't know yet how effective the surgery really is in treating lumbar degenerative disc-disease (DDD).

In this prospective study, researchers followed 99 patients for a least 12 months. The researchers looked results of the surgery, called a total lumbar disc replacement (TDR), to see how the patients with DDD fared. The patients underwent the surgery after trying other nonsurgical methods that didn't work for them.

Twenty-two of the patients had the disc replacement at the lumbosacral junction, which is just above the tailbone area. Twenty patients had it done in the same area but also a second one at a level just slightly higher at a level called L4-L5. Finally, 22 patients had the surgery only at L4-L5.

When the researchers followed up on the patients, they found that 78.7 percent of patients showed good or excellent results. For the most part, the patients who had the surgery done at the L4-L5 level alone were happiest with the treatment and outcome. The lowest patient satisfaction was among those who had the surgery done at both the lumbosacral junction and the L4-L5 area.

The same pattern followed with return to work. More patients from the L4-L5 group went back to work, the fewest number who went back were those who had the surgery done in the two areas.

The researchers also looked at the complication rates. Fewer patients who had the surgery in the lumbosacral area had complications than those in the other two groups.

The authors concluded that the level in the spine where the surgery is done and number of lumbar disc replacements plays an important role in how the patient recovers. The recommend that more studies be done and they suggest that surgeons be made aware of the lower success rate of the bisegmental replacements.
Christoph J. Siepe, MD, et al. Total Lumbar Disc Replacement. In Spine. April 2007. Vol. 32. No. 7. Pp. 782-790.