Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications

Abstract

In this prospective study, a total of 134 prosthetic discs were replaced in 108 patients undergoing total disc replacement surgeries for degenerative disc disease. It was the aim of this study to correlate the clinical findings and the outcome of our patients treated with Prodisc II prostheses for various indications and to formulate indication criteria for disc replacement surgeries. The discs were implanted at L5/S1 in 61 patients, L5/L6 in 3 patients, L4/L5 in 31 patients, L3/L4 in 7 patients, and L2/L3 in 3 patients. There were 12 patients with two-level implants: from L4 to S1 in 11 of them and from L2 to L5 in the remaining one. Two patients also had three-level implants, from L3 to S1. Follow-up evaluation included plain radiographs, physical evaluation, and subjective evaluation by the patient using the Oswestry scale, the visual analog pain scale, and the SF-36V2 well-being questionnaire. The evaluation exercise showed that 90.8% of patients had excellent results, 7.4% had good results and 1.8% had fair results, with no poor results seen. Postoperatively, the average vertebral motion was increased in all patients at the operated level. Progression of disc degeneration at the adjacent levels was noted in ten patients. The average time to resuming activities of daily living unaided was 2.3 weeks. No implant failures or complications due to surgery were encountered in this study. Total prosthesis disc replacement for degenerative disc disease was found to be a good treatment modality, provided proper patient selection and criteria are adhered to. We were able to formulate indication criteria based on this.