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Preliminary ResultPreliminary ResultTotal disc replacementTotal disc replacement
Wayne Cheng, MDWayne Cheng, MDAssistant ProfessorAssistant ProfessorDepartment of Orthopaedic SurgeryDepartment of Orthopaedic SurgeryLoma Linda University Medical CenterLoma Linda University Medical Center
September 8, 2006September 8, 2006
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HISTORYHISTORY
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HISTORYHISTORY
1955 1955 Hamby/ClevelandHamby/Cleveland– Cement injectionCement injection
1962 Nachemson1962 Nachemson– Silicone injectionSilicone injection
1964 Fernstrom1964 Fernstrom– Ball bearingBall bearing
1970’s to 80’s1970’s to 80’s– UrbaniakUrbaniak– LeeLee– KotsuikKotsuik– SteffeeSteffee
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History-PresentHistory-Present
Charite’ (depuy) Oct 04 Prodisc (synthes) Aug 06
Maverick (Medtronic)
Flexicore (stryker)
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Loma Linda Univ. Loma Linda Univ. Medical CenterMedical Center
feb 2005 to presentfeb 2005 to present 31 patients, 37 discs31 patients, 37 discs Male : female = 14 : Male : female = 14 :
1717 Age 24 to 66 (avg. Age 24 to 66 (avg.
40.7)40.7) f/u 18 month to 6 wks f/u 18 month to 6 wks
(average 7 month) (average 7 month)
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LevelsLevels
LevelsLevels L5/S1L5/S1 L45L45 L34L34 L23L23
# of # of TDRTDR
1616 1414 66 11
Total number of disc replacement = 37
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Simple TDR vs. hybridSimple TDR vs. hybrid
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Type of surgeryType of surgery
Type of surgeryType of surgery # of patients# of patients
1 level TDR1 level TDR 1717
2 level TDR2 level TDR 44
2 level hybrid2 level hybrid 55
3 level hybrid3 level hybrid 55
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ImplantsImplants
Charite 33 TDR Kineflex 4 TDR
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Pain Relief (VAS)Pain Relief (VAS)
0
10
20
30
40
50
60
70
80
90
preop 6 wks 3 month 6month 1 year
VAS
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Pain & Function (ODI)Pain & Function (ODI)
0
10
20
30
40
50
60
70
80
PRE OP 6 WKS 3 mon 6 mon 1 yr
ODI %
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Patient SatisfactionPatient Satisfaction
0
10
20
30
40
50
60
70
satisfied some what not sat
Satisf%
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“ “ will you make the will you make the same choice again?”same choice again?”
0
10
20
30
40
50
60
70
80
90
yesno
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COMPARE TO IDE COMPARE TO IDE STUDY (VAS)STUDY (VAS)
0
10
20
30
40
50
60
70
80
preop 6 wks 3 month 6month 1 year
LLUIDE
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Simple TDR vs. HybridSimple TDR vs. Hybrid(VAS for pain)(VAS for pain)
0
10
20
30
40
50
60
70
80
90
pre op 6 wks 3 mon 6 mon 1 yr
1 level tdr2 level tdr2 level hyb3 level hyb
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COMPLICATIONCOMPLICATION
Secondary surgerySecondary surgery 77
Leg painLeg pain 66
Malposition of hardwareMalposition of hardware 55
ileusileus 55
vascular injuryvascular injury 33
fracturefracture 11
Heterotopic ossificationHeterotopic ossification 11
Retrograde ejaculationRetrograde ejaculation 00
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ComplicationComplication
1 1 level level TDRTDR
2 level 2 level TDRTDR
2 level 2 level hybridhybrid
3 level 3 level hybridhybrid
MalpositioMalpositionn
0/170/17 1/41/4 3/53/5 1/51/5
22ndnd procedureprocedure
2/172/17(pain (pain
pump, pump, fracture)fracture)
2/42/4 (post decomp, (post decomp,
scoliosis)scoliosis)2/52/5 (poor (poor
exposure, disc exposure, disc tilt)tilt)
1/5 1/5 (poor (poor
position changed position changed to fusion)to fusion)
ileusileus 1/171/17 0/40/4 2/52/5 2/52/5Leg painLeg pain 2/172/17 1/41/4 2/52/5 1/51/5
Vascular Vascular injuryinjury
1/171/17 0/40/4 1/51/5 1/51/5
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CONCLUSION CONCLUSION
TDR is a viable method to achieve TDR is a viable method to achieve reasonable patients satisfactionreasonable patients satisfaction
Complication is significantly Complication is significantly higher than anticipatedhigher than anticipated
Multi-level is as good as single Multi-level is as good as single level for pain relieflevel for pain relief
Multi-level has higher Multi-level has higher complication ratecomplication rate