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  • Lumbar Total Disc Replacement by the Lateral Approach – Up to 10-year Follow-up

    Final Number:

    Luiz Pimenta MD, PhD; Luis Marchi PhD; Rodrigo Augusto Amaral MD; Leonardo Oliveira BSc; Joes Nogueira-Neto; Rubens Jensen PhD; Etevaldo Coutinho MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The XL-TDR artificial disc is placed by the lateral approach with maintenance of ALL,. The purpose of this study was to analyze results of XL-TDR for the treatment of symptomatic degenerative disc disease.

    Methods: Prospective non-randomized single-center study. . 60 cases were enrolled(31 males; 66 levels; average age 42.8y/o). 11/60 patients(18%) not completed at least a 5-year FUP, and 49 were enrolled(53 levels) in the analysis. Mean FUP =93 months(60-122). Endpoints included VAS and ODI questionnaires, radiographic outcomes (radiographs and CT) such as heterotopic ossification (HO) and maintenance of disc motion, complications, reoperation, and heterotopic ossification grades.

    Results: The mean surgical duration was 122 minutes with mean 58mL of EBL. All but three patients stood up/ walked at the same day. Five levels(10%;5/53) required to be fused. Both removal of the prostheses and interbody fusion were performed by the lateral transpsoas approach. One case due CrCo allergy(at 2 months); four due persistent pain from different causes. Two cases(4%;2/49) evolved with adjacent level disease that required surgery. One case required sacro-iliac fusion. It was identified one partial disc migration. Flex/ext films from 38 levels were available at least at a 5-year FUP. HO grade 0=13%; grade I=18%; grade II=32%; grade III=16%; grade IV= 21% (8 cases). Most heterotopic ossification cases(85%) occurred in the lateral aspect of the disc space. Patient-reported outcomes showed signi?cant improvement (p<0.01) maintained up to minimum 5y. VAS back pain: preop 8.5, postop early 2.5, and last FUP 3.0. ODI: preop 54%, postop early 31%, and last FUP 21%.

    Conclusions: The benefits of this option include minimal fast mobilization and lower rate of adjacent level disease. The data show satisfactory sustained pain relief and improved physical function for patient with the disc. Lumbar artificial disc replacement done by the lateral approach seems an effective treatment for feasible for mild DDD.

    Patient Care: Novel lumbar TDR designs may benefit patients, once previous prostheses have some drawbacks, including uncontrolled motion due to the removal of ALL.

    Learning Objectives: Identify that a lateral-placed TDR prosthesis can maintain the anterior longitudinal ligament and may provide motion preservation with good clinical outcomes and low rate of disc-related adverse events.


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