Disc Disease Severity Doesn't Predict Surgical Outcomes

Measures of disc degeneration not linked to patient's outcome after total disc replacement

THURSDAY, Nov. 8 (HealthDay News) -- Increasing severity of degenerative disc disease (DDD) does not impact outcomes in total lumbar disc replacement (TDR), according to a study published in the November issue of the European Spine Journal.

Christoph J. Siepe, M.D., Ph.D., from the Schön Klinik Munich Harlaching in Germany, and colleagues correlated data for 51 patients from prospective histological, X-ray, and magnetic resonance imaging investigation of the degree of DDD with each patient's pre- and postoperative clinical outcomes.

During an average follow-up of 51 months, the researchers found that, compared with preoperative levels, the postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly. There were significant correlations and interdependence noted between various parameters of DDD before surgery. Degenerative changes of nucleus pulposus were more pronounced than that of annulus fibrosus, and these were not correlated. The extent of DDD was not significantly associated with the patient's symptomatology before surgery. Increasing stage of DDD did not negatively influence the postoperative clinical outcome parameters following TDR. Lower disc space height scores were not linked to inferior clinical results as indicated by postoperative VAS or ODI scores, or subjective outcome at the last follow-up. Patients with more severe histological degeneration scores of nucleus pulposus samples before surgery had significantly lower VAS scores soon after surgery.

"Increasing stages of DDD did not negatively impact on the outcome following TDR in a highly selected patient population. In particular, no preoperative DDD threshold value was identified from which an inferior postoperative outcome could have been deduced," the authors write. "Conversely, some positive effects on the postoperative outcome were detected in patients with advanced stages of DDD."

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