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Title: | Early experience with lateral lumbar total disc replacement: Utility, complications and revision strategies. |
Epworth Authors: | Malham, Gregory |
Other Authors: | Parker, Rhiannon |
Keywords: | Lumbar Total Disc Replacement Total Disc Replacement TDR Spinal Surgery Back Surgery Lateral Approach Lumbar Revision Strategies Symptomatic Degenerative Disc Disease Direct Lateral Retroperitoneal, Transpsoas Approach Clinical Outcomes Lumbar Fusion Complications XL-TDR Device Prosthesis Dislocation Spinal Prosthesis Utility XL-TDR VAS ODI Oswestry Disability Index SF-36 Physical Component Scores Mental Component Scores Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia |
Issue Date: | May-2017 |
Publisher: | Elsevier |
Citation: | J Clin Neurosci. 2017 May;39:176-183. |
Abstract: | Lumbar total disc replacement (TDR) is an alternative to interbody fusion for the treatment of symptomatic degenerative disc disease. Traditionally, lumbar TDR is performed via an anterior retroperitoneal approach with regional risks of vascular and visceral injury. The direct lateral retroperitoneal, transpsoas approach avoids mobilisation of the great vessels and preserves the anterior longitudinal ligament, thereby maintaining physiological limits on motion. This study aimed to (i) report one site's early experience with lateral lumbar TDR and (ii) provide case examples illustrating the utility, complications and revision strategies of the XL-TDR device. Data were collected prospectively on the first 12 consecutive patients treated with XL-TDR. Patient outcomes included pain (VAS), disability (ODI), and quality of life (SF-36 PCS and MCS). Mean follow-up was 27.5months (range 18-48months). Patients had significant improvements in back (74%) and leg (50%) pain, ODI (69%), PCS (50%) and MCS (39%) (P<0.05). Two patients had early prosthesis dislocation due to prosthesis undersizing. The same skin incision was used to retrieve the XL-TDR and perform salvage lateral lumber interbody fusion, with solid fusion by 12months. Lumbar TDR using the XL-TDR via a lateral transpsoas muscle-splitting approach is a minimally invasive alternative to anterior retroperitoneal exposures for motion preservation. Correct sizing of the XL-TDR and complete contralateral annulectomy with annulus box cutters mitigates the risk of lateral dislocation. Revision surgery for lateral dislocation of the XL-TDR is more straightforward compared to anterior TDR dislocation. |
URI: | http://hdl.handle.net/11434/1040 |
DOI: | 10.1016/j.jocn.2017.01.033 |
PubMed URL: | https://www.ncbi.nlm.nih.gov/pubmed/28215460 |
ISSN: | 0967-5868 |
Journal Title: | Journal of Clinical Neuroscience |
Type: | Journal Article |
Type of Clinical Study or Trial: | Prospective Study |
Appears in Collections: | Musculoskeletal Neurosciences |
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