Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether endoscopic discectomy (ED) shows superiority compared with the current gold standard of microdiscectomy (MD) in management of lumbar disc disease. Materials and Methods: We conducted independent and duplicate electronic database search including PubMed, Embase, and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMeta[Analyst] software. Results: We included 27 studies, including 11 randomized controlled trials (RCTs), 7 nonrandomized prospective, and 9 retrospective studies involving 4018 patients in the meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analyzing the RCTs, superiority was established at 95% confidence interval for ED compared with MD in terms of functional outcomes like Oswestry Disability Index (ODI) score ( P = .008), duration of surgery ( P = .023), and length of hospital stay ( P < .001) although significant heterogeneity was noted. Similarly, noninferiority to MD was established by ED in other outcomes like visual analogue scale score for back pain ( P = .860) and leg pain ( P = .495), MacNab classification ( P = .097), recurrences ( P = .993), reoperations ( P = .740), and return-to-work period ( P = .748). Conclusion: Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and noninferiority in other measures analyzed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.

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Total disc replacement in the lumbar spine: a systematic review of the literature

European Spine Journal ◽

10.1007/s00586-006-0186-9 ◽

2006 ◽

Vol 15 (S3) ◽

pp. 439-447 ◽

Cited By ~ 100

Author(s):

Brian J. C. Freeman ◽

James Davenport

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Total Disc Replacement ◽

Disc Replacement ◽

Review Of The Literature

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The Use of Percutaneous Lumbar Fixation Screws for Bilateral Pedicle Fractures with an Associated Dislocation of a Lumbar Disc Prosthesis

Case Reports in Orthopedics ◽

10.1155/2013/676017 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

William D. Harrison ◽

David J. Harrison

Keyword(s):

Back Pain ◽

Lumbar Disc ◽

Excellent Result ◽

Total Disc Replacement ◽

Pedicle Screws ◽

Disc Replacement ◽

Disc Disease ◽

Lumbar Total Disc Replacement ◽

Plain Films ◽

Fusion Cage

Study Design.Case report.Objective.To identify a safe technique for salvage surgery following complications of total disc replacement.Summary of Background Data.Lumbar total disc replacement (TDR) is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation.Methods and Results.A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor.Conclusion.The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf.

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