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Early Outcomes of Lumbar Spinal Disc Replacement vs. Fusion in Community Practices

This study compares the early results of lumbar total disc replacement (TDR) and spinal fusion (ASF/PSF) in a community practice setting. It involved 26 TDR and 62 single-level fusion patients, as well as hybrid constructs in 21 cases. Outcomes assessed included hospitalization, pain severity, disability, and secondary operations over various follow-up periods. Results indicated significant improvement in both groups, with TDR showing superior outcomes in single-level cases regarding disability indices and a trend towards less reoperation. The findings suggest favorable results for selected TDR and hybrid patients.

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Early Outcomes of Lumbar Spinal Disc Replacement vs. Fusion in Community Practices

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  1. Glenn R. Buttermann, MD Lumbar Spinal Disc Replacement in a Community Practice Setting: Early Results

  2. Intro: Lumbar TDR • Comparative studies for a lumbar TDR in a community setting outside of an IDE setting are few. • Purpose: compare a lumbar TDR for one level conditions, as well as “off-label” combination of disc replacement and spinal fusion as a “hybrid” construct for multilevel conditions, to fusion in a community spine practice.

  3. Methods • TDR (n=26) and single-level fusion (n=62) cohorts • TDR hybrids (n= 21) and 2-level A/P fusion (n=50) cohorts • Prospective outcomes • Hospitalization (LOS, EBL, implant costs) • Revisions, 2ndary operations

  4. Lumbar TDR vs ASF/PSF

  5. Low Back Pain Outcomes

  6. Leg Pain Outcomes

  7. Pain Drawing Outcomes

  8. Disability Outcomes

  9. Results • Both TDR and spinal fusion groups had significantly improved outcomes at all follow-up periods for both single and multilevel cases. • There was no significant difference in outcomes between single level and multilevel cases within both the fusion and TDR groups. • Single level cases, the TDR group had significantly greater ODI improvement relative to the fusion group at all follow-up periods. • Single level TDR had trend for greater VAS improvement at 1-2yr and 2-4 yr follow-up periods.

  10. Results • For multi-level cases, the improvement was similar for the hybrid and fusion group at all follow-up periods. • Implant costs were less for single level total disc replacement compared to spinal fusion but equivalent or greater for hybrid constructs compared to multilevel fusion constructs. • Range of motion was maintained in the total disc replacement groups. • Secondary surgeries were greater for the fusion groups (instrumentation removal and adjacent segment conditions).

  11. Discussion • Outcomes of current 1-level study similar to IDE studies. • Current TDR (& hybrid reconstructions) outcomes equivalent to or better than fusion for properly selected patients. • Lower short-term reoperation rates for TDR group.

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