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

HISTORYHISTORY

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

History-PresentHistory-Present

Charite’ (depuy) Oct 04 Prodisc (synthes) Aug 06

Maverick (Medtronic)

Flexicore (stryker)

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)

LevelsLevels

LevelsLevels L5/S1L5/S1 L45L45 L34L34 L23L23

# of # of TDRTDR

1616 1414 66 11

Total number of disc replacement = 37

Simple TDR vs. hybridSimple TDR vs. hybrid

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

ImplantsImplants

Charite 33 TDR Kineflex 4 TDR

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

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 %

Patient SatisfactionPatient Satisfaction

0

10

20

30

40

50

60

70

satisfied some what not sat

Satisf%

“ “ 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

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

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

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

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

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