Retrospective Study on Effectiveness of Activ L Total Disc Replacement

Background: The effectiveness of lumbar total disc replacement (TDR) with different prostheses for sagittal alignment has been reported previously. However, there are only few reports on Activ L TDR and no specific evidence regarding whether sagittal alignment affects the clinical outcomes.Methods: 87 patients who underwent mono- or bi-segmental lumbar TDR with ActivL were studied. The films of upright anteroposterior and lateral spine in neutral, flexion, and extension positions were obtained before surgery and at 1 month, 1 and 3 years after surgery. The radiographic parameters such as lumbar lordosis (LL), index level lordosis (IL), pelvic incidence (PI), pelvic tilt (PT), segmental lordosis (SL) and sacral slope (SS) were measured based on the lateral upright radiographs. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analogue scale (VAS) pre- and post-operatively.Results: 87 patients with complete radiographic data were available for a 3-year follow-up period. Of these, 66 received a single-level TDR, and 21 received 2-level TDR. At 1 month, the mean LL was similar to the pre-operative data, and then was significantly increased to 45.1° at 3 years. On an average, the IL tended to significantly increase, while the mean SL at L4-5 was increased from 16.5° pre-operatively to 21.0° at 3 years. The mean SL at L1-2, L2-3, L3-4, and L5-S1, PI, PT and the SS showed no obvious difference after 3 years. In contrast, VAS and ODI scores showed significant improvement after surgery.Conclusions: Activ L TDR showed favorable affect on sagittal alignment, enhancing the IL while preserving the LL and SS. However, satisfactory clinical results for over a 3-year follow-up were not affected by sagittal alignment.