Treatment of Discogenic Low Back Pain by Total Disc Arthroplasty using the Prodisc Prosthesis: Analysis of a Prospective Cohort Study with Five- Year Clinical Follow-Up

ABSTRACT

Few studies are available for the long-term outcome of disc arthroplasty using the Prodisc prostheses. We evaluated if total disc arthroplasty using the Prodisc prosthesis could be a reliable treatment for disabling low-back pain, and if long lasting improvement in quality-of-life could be achieved. We hypothesized that analysis of a prospective cohort study with a mean 5-year follow-up, clinical control, done by rheumatologists not involved in treatment would provide data that was not influenced by surgeon bias. Thirty-nine patients undergoing disc replacement between May 2002 and July 2004 were the study population. Fifty-two levels from L2 to S1, of which 28 were single-level, 9 were double-level and two were three levels, were treated. Independent clinical evaluation by uninvolved rheumatologists was done preoperatively at 1, 2 and 5 years after surgery. The Visual Analogue Score (VAS) for leg and lumbar pain intensity, Oswestry Low Back Pain Disability Index (ODI), Short Form-36 (SF-36), patient satisfaction, and the return to work rate were assessed. Analysis revealed a significant amelioration of the VAS for back and leg pain, as well as for the ODI and the SF-36. Since this is a motion preservation device study it is important to include range of motion ROM analysis at the follow-up times. These data suggest that total disc arthroplasty using the prodisc prosthesis is a good treatment option for disabling discogenic low back pain. The improvement achieved after 1 year could be conserved at 2- and 5-year follow up.