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• W3085192667 abstract "BACKGROUND CONTEXT Results of lumbar total disc replacement (TDR) have consistently been reported to be similar or superior to lumbar interbody fusion in appropriately selected patients. However, the indications for TDR are less broad than for fusion. PURPOSE The purpose of this study was to investigate the reasons and their frequency for why TDR specialty surgeons performed lumbar fusion rather than TDR. STUDY DESIGN/SETTING The study was based on a retrospective review of a consecutive case series at a spine specialty clinic. PATIENT SAMPLE The study was based on the consecutive series of 515 patients undergoing lumbar TDR or fusion during a 5-year period by three surgeons specializing in TDR. OUTCOME MEASURES The primary outcome measures for the study were: the type of surgery performed (TDR vs fusion), and the reason why fusion was performed rather than TDR. METHODS For each fusion, the reason for not performing TDR was recorded. The primary reason for not performing TDR were classified into categories such as significant facet changes, insurance noncoverage/denial, significant spondylolisthesis, combined pathologies, etc. The “combined” category was used for patients with multiple related problems such as severe stenosis, disc space collapsed, spondylolisthesis and/or segmental instability. RESULTS During the study period, 65.4% (n=337) of patients underwent TDR and the remaining 34.6% (n=178) underwent lumbar interbody fusion (stand-alone ALIF or ALIF combined with posterior instrumentation +/- fusion). Of the 178 fusion patients, the most common reason for fusion vs TDR was combined factors which occurred in 59 patients (11.5%). The second most common reason was greater than Grade 1 spondylolisthesis (n=32, 6.2%), followed by insurance noncoverage (n=24, 4.7%) and 13 did not receive TDR due to osteopenia/osteoporosis (2.5%). There were pars defects in 11 patients (2.1%), degenerative deformity in 9 patients (1.7%) and pseudarthrosis repair led to fusion in 6 patients (1.2%). Other reasons for fusion included significant facet joint degeneration and/or painful facets (n=4, 0.8%), bridging osteophytes (0.4%), and significant scarring from prior discectomy (n=2, 0.4%). There was one case (0.2%) each of: possible metal allergy, pedicle fracture, apophyseal ring defect, intraspinal extradural mass, annular cyst, TDR removal, TLIF cage removal, ankylosing spondylitis, rheumatoid arthritis, high sacral slope, possible post-stem cell injection discitis (performed remote), and one patient opted for fusion instead of TDR. In 4 patients (0.8%) the reason for fusion vs TDR could not be clearly determined from the chart review. Fusion patients’ mean age was significantly greater than TDR patients (52.5 vs 41.6 years; p CONCLUSIONS The most common reason for not performing lumbar TDR was related to factors that may compromise the stability of the operated segment and/or functionality of the TDR. The older age may be related to these factors as well as segmental degenerative deformity leading to fusion. The results of this study found that many patients are good candidates for lumbar TDR. However, even among TDR specialists, fusion may be preferred in some patients where it is prudent to not take undue risks. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs." @default.
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• W3085192667 date "2020-09-01" @default.
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• W3085192667 title "P64. In which cases do surgeons specializing in total disc replacement perform fusion in patients with symptomatic lumbar disc degeneration?" @default.
• W3085192667 doi "https://doi.org/10.1016/j.spinee.2020.05.462" @default.
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