2007, Number 1
<< Back Next >>
Cir Cir 2007; 75 (1)
Experience with prosthetic disc nucleus device in Mexico. Final report of a 4-year follow-up
Rosales-Olivares LM, Pérez-Víquez A, Miramontes-Martínez V, Alpízar-Aguirre A, Reyes-Sánchez AA
Language: Spanish
References: 33
Page: 31-36
PDF size: 87.24 Kb.
ABSTRACT
Background: Discal hernia is generally treated by discectomies that are mutilating and cause instability and low back pain in 50% of the patients. Partial arthroplasty is used in an attempt to avoid degeneration after a discectomy.
Methods: Nineteen patients from the INR (National Institute of Rehabilitation) were selected with extruded discal hernia. All inclusion criteria were met, with a minimal follow-up of 4 years. Evolution was evaluated with the Oswestry scale (OS) and x-ray studies. Statistical analysis was done with Student’s t-test.
Results: Sixteen men and three women were included in the study, with an average age of 35.4 years. OS before surgery was 57.37% and improved to 22% (p 0.001). The results obtained in the Prolo scale 4 years later were for the economy scale, p 0.001 (Wilcoxon Z = 3.87) and for the functional scale, p 0.001 (Wilcoxon Z = -3.94). The intervertebral space height (IS) before surgery was 6 and 8 mm, and 4 years later, in 12 patients it remained between 8 and 10 mm. The prosthesis had variations according to its initial placement in seven patients, and in all there was subsidence. In two cases migration surpassed the limits of the vertebral body without clinical repercussion. None of the patients required re-operation.
Conclusions: Prosthetic disc nucleus device improved clinical conditions and x-rays of the patients using Oswestry, Prolo and intersomatic space height enhancement after 4 years of follow-up in 12/19 patients.
REFERENCES
Bushell GR, Glosh P, Taylor TF, Akeson WH. Proteoglycan chemistry of the intervertebral discs. Clin Orthop 1977;129:115-123.
Studer A. Nucleus prosthesis: a new concept. Eur Spine J 2002; 11(suppl 2):S154-S156.
Bao QB, Higham PA. Hydrogel bead intervertebral disc nucleus. U.S. Patent 5192326;1993.
Woertgen C, Rothoerl RD, Breme K, et al. Variability of outcome after lumbar disc surgery. Spine 1999;24:807-811.
Kostuik JP. Alternatives to spinal fusion. Orthop Clin North Am 1998;29;701-715.
Bao QB, McCullen GM, Higham PA, Dumbleton JH, Hyuan HA. The artificial disc: theory design and materials. Biomaterials 1996;12:1157-1167.
Bertagnoli R, Kumar S. Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J 2002;11(suppl 2):S131-S136.
Bertagnoli R, Sachs BL, Ray CD, Pimenta L. Modified surgical technique for implantation of prosthetic disc nucleus device. Presented at the International Meeting of Advanced Spine Techniques, Paradise Island, Bahamas;2001.
David T. Lumbar disc prosthesis: surgical technique, indications and clinical results in 22 patients with a minimum of 12 months follow-up. Eur Spine J 1993;1:254-259.
Enker P, Steffee A, McMillin C, Keppler L, Biscup R, Miller S. Artificial disc replacement. Preliminary report with a 3-year minimum follow-up. Spine 1993;10:1061-1070.
Link HD. History, design and biomechanics of the LINK SB Charité artificial disc. Eur Spine J 2002;11(suppl 2):S98-S105.
Mayer MH, Korge A. Non-fusion technology in degenerative lumbar spinal disorders: facts, questions, challenges. Eur Spine J 2002;11(suppl 2):S85-S91.
Ray CD, Sachs BL, Norton BK, Mikkelsen ES, Clausen NA. Prosthetic disc nucleus implants: an update. In: Gunzburg R, Szpalski M, eds. Lumbar Disc Herniation. Philadelphia: Lippincott;2002.
Ray CD. The PDN prosthetic disc-nucleus device. Eur Spine J 2002;11(suppl 2):S137-S142.
Szpalski M, Gunzburg R, Mayer M. Spine arthroplasty: a historical review. Eur Spine J 2002;11(suppl 2):S65-S84.
Ito T, Takano Y, Yuasa N. Types of lumbar herniated disc and clinical course. Spine 2001;26:648-651.
Bernick S, Walker JM, Paule WJ. Age changes to the annulus fibrosus in human intervertebral discs. Spine 1991;16;520-524.
Wiltse LL, Rocchio PD. Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of low-back syndrome. J Bone Joint Surg Am 1975;57;478-483.
Scott AH, Harrison DJ. Increasing age does not affect good outcome after lumbar disc replacement. Int Orthop 2000;24:50-53.
Shim CS, Lee SH, Park CW, et al. Partial disc replacement with the PDN prosthetic disc nucleus device. Early clinical results. J Spinal Disord Techniques 2003;16:324-330.
Hochschuler SH, Ohnmeiss DD, Guyer RD, Blumenthal SL. Artificial disc: preliminary results of a prospective study in the United States. Eur Spine J 2002;11(suppl 2):S106-S110.
Bertagnoli R, Vázquez RJ. The anterolateral transpsoatic approach (ALPA): a new technique for implanting prosthetic disc nucleus device. Spine 2003;28:398-404.
Cinotti G, David T, Postacchini F. Results of disc prosthesis after a minimum follow-up period of 2 years. Spine 1996;21:995-1000.
Klara PM, Ray CD. Artificial nucleus replacement. Clinical experience. Spine 2002;27:1374-1377.
Korge A, Nydegger T, Polard JL, Mayer HM, Husson JL. A spiral implant as nucleus prosthesis in the lumbar spine. Eur Spine J 2002;11(suppl 2):S149-S153.
Kotani Y, Abumi K, Shikinami Y. Artificial intervertebral disc replacement using bioactive three dimensional fabric: design, development and preliminary animal study. Spine 2002;27:929-936.
Wilke HJ, Sinead Kavanagh S, Neller S, Haid C, Lutz Eberhart C. Effect of a prosthetic disc nucleus on the mobility and disc height of the L4-5 intervertebral disc postnucleotomy. J Neurosurg (Spine 2) 2001;95:208- 214.
Yaszems MJ, White AA, Panjabi MM. Biomechanics of the spine. Spine 2002;48:15-23.
Bertagnoli R, Schönmayr R. Surgical and clinical results with the PDN prosthetic disc-nucleus device. Eur Spine J 2002;11(suppl): S143-S148.
Guyer RD, Ohnmeiss DD. Intervertebral disc prothesis. Spine 2003;28:15-23.
Bao QB, Yuan HA. Prosthetic disc replacement. Spine 2002;48;477-448.
De Kleuver M, Oner FC, Jacobs WC. Total disc replacement for chronic low back pain: background and systematic review of the literature. Eur Spine J 2003;12:108-116.
Dadi J, Dongbin Q, Liang Z, Jianting XCh, Jianming J. Prosthetic disc nucleus (PDN) replacement for lumbar disc herniation. Preliminary report with six months’ follow-up. J Spinal Disord Techniques 2003;16:331-337.