Mid- to long-term results of total disc replacement for lumbar degenerative disc disease: a systematic review.
BACKGROUND
Lumbar total disc replacement (TDR) has shown satisfactory clinical outcomes with few complications and reoperations at short-term follow-up, but the mid- to long-term results are not clear.


PURPOSE
The objective of this study was to evaluate the mid- to long-term clinical outcomes of artificial TDR for lumbar degenerative disc diseases.


PATIENTS AND METHODS
A systematic search was conducted using the PubMed database to identify studies of TDR surgery that included at least 3 years of follow-up. The search keywords were as follows: lumbar, total disc replacement, and arthroplasty. The following data were extracted: patient demographics, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, satisfactory rate, clinical success rate, complications, and reoperations.


RESULTS
Thirteen studies, including eight prospective studies and five retrospective studies, met the criteria. A total of 946 patients were identified who reported at least 3 years of follow-up results. The artificial prostheses in these studies were ProDisc-L, Charité, AcroFlex, Maverick, and XL TDR. Patients with lumbar TDR demonstrated significant improvements in VAS scores of 51.1 to 70.5% and of - 15.6 to - 44.4 for Oswestry disability index (ODI) scores at the last follow-up. Patient satisfaction rates were reported in eight studies and ranged from 75.5 to 93.3%. Complication rates were reported in 11 studies, ranging from 0 to 34.4%. The overall reoperation rate was 12.1% (119/986), ranging from 0 to 39.3%, with eight of the 13 studies reporting a reoperation rate of less than 10%.


CONCLUSIONS
This review shows that lumbar TDR effectively results in pain relief and an improvement in quality of life at mid- to long-term follow-up. Complication and reoperation rates were acceptable. However, this study did not provide sufficient evidence to show that lumbar TDR is superior to fusion surgery. To answer that question, a greater number of high-quality randomized controlled trials (RCTs) are needed.
['Cui|Xu-Dong|XD|', 'Li|Hai-Tao|HT|', 'Zhang|Wen|W|', 'Zhang|Lin-Lin|LL|', 'Luo|Zong-Ping|ZP|', 'Yang|Hui-Lin|HL|']
D006801:Humans D055959:Intervertebral Disc Degeneration D017116:Low Back Pain D008159:Lumbar Vertebrae D017060:Patient Satisfaction D011788:Quality of Life D012086:Reoperation D059145:Total Disc Replacement
Systematic review Lumbar total disc replacement Mid- to long-term follow-up