Total Disc Replacement, Spinal Fusion Reach Surgical Goals

However, no correlation between fulfillment of surgical goals and back pain or disability

FRIDAY, Dec. 2 (HealthDay News) -- Surgical goals are reached for most patients undergoing spinal fusion or total disc replacement (TDR) for chronic low back pain (CLBP) that is assumed to be discogenic, but this is not correlated to clinical outcome, according to a study published in the November issue of The Spine Journal.

Svante Berg, M.D., Ph.D., from Löwenströmska Hospital in Stockholm, Sweden, and colleagues analyzed X-ray measurements from 72 patients who underwent instrumented surgical spinal fusion and 80 patients who underwent TDR surgeries for CLBP that was assumed to be discogenic, and compared the results with clinical outcomes. Using distortion-compensated Roentgen analysis (DCRA), flexion-extension X-rays of the treated and adjacent segments were assessed preoperatively and two years postoperatively, and postoperative mobility was estimated. Between-group disc height changes and range of motion (ROM) respective translation in adjacent levels were compared.

The investigators found that the fusion and TDR groups had similar preoperative flexion-extension ROM, with the segments to be treated having a preoperative disc height between one and two standard deviations less than previously established heights in a normative database. No mobility was found in 70 percent of fused patients, and 85 percent of TDR patients were mobile. There was no correlation between fulfillment of surgical goals and either back pain or disability. Postoperatively, fused segments were lower than normative values, while TDR segments were higher. The fusion group showed significantly more translation and flexion-extension in the adjacent segments than in the TDR group.

"This very accurate X-ray method (DCRA) indicates that surgical goals were reached in most patients. This, however, was not correlated to clinical outcome," the authors write.

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