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- Title
Lumbar total disc replacement: predictors for long-term outcome.
- Authors
Furunes, Håvard; Hellum, Christian; Brox, Jens Ivar; Rossvoll, Ivar; Espeland, Ansgar; Berg, Linda; Brøgger, Helga Maria; Småstuen, Milada Cvancarova; Storheim, Kjersti
- Abstract
<bold>Purpose: </bold>We aimed to identify patient characteristics associated with favourable long-term outcomes after lumbar total disc replacement (TDR).<bold>Methods: </bold>We analysed a cohort of 82 patients with degenerative disc and chronic low back pain (LBP) who were treated with TDR and originally participated in a randomised trial comparing TDR and multidisciplinary rehabilitation. Potential predictors were measured at baseline, and the outcomes assessed 8 years after they received allocated treatment. Outcome measures were dichotomised according to whether the participants achieved a clinically important functional improvement (15 points or more on the Oswestry Disability Index, ODI) (primary outcome) and whether they were employed at 8-year follow-up (secondary outcome). Associations between potential predictors and outcomes were modelled using logistic regression. For the secondary outcome, the results were also organised in a prediction matrix and expressed as probabilities.<bold>Results: </bold>For 71 patients treated with TDR according to protocol, the follow-up time was 8 years. For a subgroup of 11 patients randomised to rehabilitation who crossed over and received TDR, the median postoperative follow-up time was 72 (range 41-88) months. Of all assessed baseline variables, only presence of Modic changes (type 1 and/or 2) was statistically significantly associated with an improvement of ≥ 15 ODI points. The probability of employment at 8-year follow-up was 1% for patients with ≥ 1 year of sick leave, comorbidity, ODI ≥ 50 and ≤ 9 years of education prior to treatment, and 87% for patients with < 1 year of sick leave, no comorbidity, ODI < 50 and higher education.<bold>Conclusions: </bold>Patients with Modic changes prior to the TDR surgery were more likely to report a clinically important functional improvement at long-term follow-up. Comorbidity, low level of education, long-term sick leave and high ODI score at baseline were associated with unemployment at long-term follow-up.
- Subjects
DEGENERATION (Pathology); LUMBAR vertebrae diseases; LUMBAR vertebrae surgery; PAIN management; LUMBAR pain; MEDICAL rehabilitation; ARTIFICIAL joints; FUNCTIONAL assessment; LONGITUDINAL method; SPINE diseases; STATISTICAL sampling; SICK leave; UNEMPLOYMENT; COMORBIDITY; EDUCATIONAL attainment; RANDOMIZED controlled trials
- Publication
European Spine Journal, 2018, Vol 27, Issue 3, p709
- ISSN
0940-6719
- Publication type
journal article
- DOI
10.1007/s00586-017-5375-1