Pain in various phases of development and clinical trials(Journal

Pain Scale and
Radiological Comparison of Lumbar Discectomy Patients with and without Lumbar
Disc Prosthesis

 

INTRODUCTION:

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Intervertebral discs(IVDs) have composite structures
surrounded by a collagen rich annulus fibrosus composed of rich core pulps of
gelatinous proteoglycan. (Orthop Clin North Am. 2011 Oct; 42(4): 487–499.Biomechanics of Intervertebral Disc Degeneration, Nozomu Inoue, Alejandro A. Espinoza Orías). The proteoglycan in the nucleus pulposus provides high
water content, and in turn, contributes to sustain large loads applied to the
vertebral body(Orthop Clin North Am. 2011 Oct; 42(4): 487–499.Biomechanics of Intervertebral Disc Degeneration, Nozomu Inoue, Alejandro A. Espinoza Orías). And IVDs are mainly avascular so it
is not surprising that degenerative disk disease(DDD) is a common phenomenon in
middle age(Spine J. 2005
May-Jun;5(3):297-309.Influence of spine morphology on intervertebral disc loads
and stresses in asymptomatic adults: implications for the ideal spine. Keller TS1, Colloca CJ, Harrison DE, Harrison DD, Janik TJ.). The
treatment of DDD is highly variable; it ranges from intensive rehabilitation to
surgical stabilisation of the spine(Lee WT
S?NGAPORE med j). The use of an artificial disc for symptomatic
DDD has been practiced for many years and is currently in various phases of
development and clinical trials(Journal of Neurosurgery: Spine
September
2004 / Vol. 1 / No. 2 / Pages 143-154, Neurological complications of lumbar
artificial disc replacement….). There are a wide variety
of new products, procedures and techniques currently in development to enhance
spine surgery and many spine surgeons believe that artificial disc technology
holds real promise for significiantly improving the standart of care for many
patients(Journal of Neurosurgery: Spine September 2004 /
Vol. 1 / No. 2 / Pages 143-154, Neurological).

Janz
et al. performed the first total discectomy and insertion of disc prosthesis(Buttner-Janz, K. Schellnack and H. Zippel, An
alternative treatment). Since the day the prosthesis was first used,
more than 15 patent applications were filed for disc prosthesis device. And
almost all of them general opinion was the artificial intervertebral disc is
preferably  designed to restore disc
height and natural disc curvature, allow  for a natural range of motion, absorb shock
and provide resistance to motion and axial compression(Siemionow
KB, Hu X, Lieberman H, The Fernstrom ball revisited, Eur Spine J, 443-448,2012).
So insertion of disc prosthesis
intends to avoid fusion related negative side effects by means of motion
preservation(Zigler J, MD Lumbar Artificial Disc Surgery for Chronic
Back Pain, Spine-Health, 2005)).

It
remains unclear whether the early fair to good results obtained with an
artificial disc will be consistently maintened with a longer follow-up period.
Therefore we investigated whether it will be a meaningful and benefical result,
protecting the disc height and foramen diameter that disc prosthesis can get
it. And we want to present the results of our clinic comparetively with only
discectomy patients.

 

 

MATERIALS
AND METHODS:

               The ethics committee approval of this study was taken from Erzurum Regional Training and Research Hospital. This study presents the retrospective examinations of  114 patients who were diagnosed with lumbar disc hernia and underwent surgery between 2010 and 2014 in the Neurosurgical Clinic of Erzurum Regional Training and Research Hospital. Patients were divided into two groups. There were 57 patients in group 1 who were performed single level discectomy and there were 57 patients in group 2 who were placed lumbar disc prosthesis after single level discectomy. A total of 57 lumbar total disc prosthesis (TDP) were inserted. We used NUBACTM disc prosthesis constructed in a unique two-piece design of a polyaryletherketone(PEEK) biomaterial with an inner ball/socket articulation launched by Victrex® in 1998. There were 32 males and 25 females in group 1 and the mean age was 38.4 (31-45). And in group 2 there were 33 males, 24 were females and the mean age was 39.1 (33-45) as seen in table 1. 30 of the patients in group 1 were operated from L4-L5 segment and 27 of the patients were operated from L5-S1 segment. And in group 2, 31 patients were operated from L4-L5 segment and 26 patients were operated from L5-S1 segment. For all the patients in our study  the exclusion criterias were previous disc surgery, spondylolisthesis, spinal stenosis, Pfirrmann grade 4-5 and overheight patient (BMI >30).               Preoperatively and postoperatively in the 3rd year, the disc height from the middle of the superior border of the disc to the middle of the inferior border of the disc with the inclusion of both endplates and the diameter of the foramen from the largest region were measured with x-ray graphies for all patients. In our radiology department, all patients are x-rayed at the same position and at the same distance.                And patients rated their pain on the Visual Analogue Scale (VAS) preoperatively and postoperatively in the 3rd year. For group 2 patients we used NUBACTM disc prosthesis constructed in a unique two-piece design of a polyaryletherketone(PEEK) biomaterial with an inner ball/socket articulation launched by Victrex® in 1998.                 Statistical analyzes were performed using paired t test and linear regression. P

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