Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Non-operative Treatment: A Randomized Study With Eight-year Follow-up.
Furunes, Håvard; Hellum, Christian; Espeland, Ansgar; Brox, Jens Ivar; Småstuen, Milada C; Berg, Linda; Storheim, Kjersti
Journal article, Journal article, Peer reviewed
Accepted version
Date
2018-12-01Metadata
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Furunes H, Hellum C, Espeland A, Brox JI, Småstuen MC, Berg L, Storheim K. Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Non-operative Treatment: A Randomized Study With Eight-year Follow-up.. Spine. 2018;43(24):1695-1703 http://dx.doi.org/10.1097/BRS.0000000000002712Abstract
Study design: Randomized controlled multicenter trial with eight-year follow-up.
Objective; To assess the long-term development of adjacent disc degeneration (ADD) after
lumbar total disc replacement (TDR) or non-operative treatment, and to analyze the
association between ADD development and clinical outcome.
Summary of background data: TDR was introduced as a motion-preserving alternative to
spinal fusion, which has been reported to increase the risk of ADD. However, ADD may
develop naturally regardless of any surgery, and no randomized study has assessed the long
term development of ADD after TDR versus non-operative treatment.
Methods: The study included 126 of the 173 patients with chronic low back pain (LBP)
originally included in a randomized study comparing TDR with multidisciplinary
rehabilitation. Magnetic resonance imaging (MRI) of the lumbar spine was performed before
treatment and at eight-year follow-up. ADD was categorized as increased or not increased
based on an evaluation of Modic changes, disc height reduction, disc contour, herniation size,
nucleus pulposus signal and posterior high intensity zones. We used a χ2 test or a Fisher’s
exact test to compare crude proportions, and multiple linear regressions to analyze the
association between increased ADD (yes/no) and change in Oswestry Disability Index (ODI)
from pre-treatment to follow-up. Results: ADD increased (for at least one ADD variable) in 23 of 57 patients (40%) treated
non-operatively, and 29 of 69 patients (42%) treated with TDR (p=0.86). We found no
significant associations between ADD increase and the change in ODI.
Conclusions: Increased ADD occurred with similar frequency after TDR and after non
operative treatment, and was not related to the clinical outcome at eight-year follow-up.