Related Articles Re: Blondel B, Tropiano P, Gaudart J, Huang RC, Marnay T. Clinical results of lumbar total disc arthroplasty in accordance with Modic signs, with a 2-year-minimum follow-up. Spine 2001;36:2309âÂ?Â?15. Spine (Phila Pa 1976). 2012 May 15;37(11):1014-5; author reply 1016 Authors: Kovacs FM, Abraira V, Arana E, GÃ?©rvas J, Royuela A, Ã?lvarez-Galovich L, BagÃ?³…

Related Articles Metal on metal lumbar total disc arthroplasty: Ready for prime time? World Neurosurg. 2012 Apr 28; Authors: Wang MY PMID: 22548877 [PubMed – as supplied by publisher]

Spinal Arthroplasty: Are There More Data for Cervical than Lumbar Spine?

World Neurosurg. 2011 Dec 17;

Authors: Wu JC, Tu TH, Mummaneni PV

PMID: 22381284 [PubMed – as supplied by publisher]

Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty.

Spine J. 2012 Jan 5;

Authors: Prather H, Van Dillen LR, Kymes SM, Armbrecht MA, Stwalley D, Clohisy JC

BACKGROUND CONTEXT: Despite the common prevalence of lumbar spine and degenerative hip disorders, there are few descriptions of patients with coexisting hip disorders and lumbar spine disorders (LSDs). The independent economic burden of each disorder is substantial, but the financial burden when the disorders are coexisting is unknown. PURPOSE: To determine the prevalence of coexisting hip disorders and LSDs in a large cohort of patients with hip osteoarthritis (OA) treated with total hip arthroplasty (THA) as well as the impact on pain and functional THA outcomes and physician charges. STUDY DESIGN: This is a retrospective study performed at a tertiary university. PATIENT SAMPLE: Three thousand two hundred six patients underwent total hip replacement from 1996 to 2008. OUTCOME MEASURES: Self-report measures: visual analog scale. Functional measures: modified Harris Hip Score (mHHS) and University of California Los Angeles (UCLA) hip questionnaire. Economic impact measures: physician medical charges. METHODS: International Classification of Diseases, Version 9, billing codes related to LSDs were cross-referenced with the 3,206 patients who had undergone a THA to determine which patients were also evaluated by a spine specialist. Demographic, hip clinical outcomes, and physician charges for patients with THA alone (THA alone) were compared with patients treated with THA and diagnosed with an LSD (THA+LSD). RESULTS: Of 3,206 patients who underwent THA, 566 (18%) were also evaluated by a spine specialist. Of those with an LSD, 334 (59%) were women with an older average age (64.5±13.3 years) compared with patients treated with THA alone (51%, 58.5±15.5 years, p=.0001). Patients in the THA alone group as compared with the THA+LSD group had greater improvement in the mHHS (p=.0001), UCLA score (p=.0001), and pain (p=.0001). Patients in the THA+LSD group incurred on average $2,668 more in charges per episode of care as compared with patients in the THA alone group (p<.001). Patients in the THA+LSD group had more days per episode of care (p=.001). CONCLUSIONS: Patients undergoing THA alone had greater improvement in function and pain relief with fewer medical charges as compared with patients undergoing a THA and treatment for an LSD. The prevalence of coexisting hip disorders and spine disorders is likely higher than currently documented. Further study is needed to improve therapeutic recommendations and determine the potential for reduction in medical expenses associated with concurrent treatment of hip OA and LSDs.

PMID: 22227176 [PubMed – as supplied by publisher]

Postoperative improvement in health-related quality of life: a national comparison of surgical treatment for focal (one- to two-level) lumbar spinal stenosis compared with total joint arthroplasty for osteoarthritis.

Spine J. 2011 Nov;11(11):1033-41

Authors: Rampersaud YR, Wai EK, Fisher CG, Yee AJ, Dvorak MF, Finkelstein JA, Gandhi R, Abraham EP, Lewis SJ, Alexander DI, Oxner WM, Davey JR, Mahomed N

BACKGROUND CONTEXT: The results of single-center studies have shown that surgical intervention for lumbar spinal stenosis yielded comparable health-related quality of life (HRQoL) improvement to total joint arthroplasty (TJA). Whether these results are generalizable to routine clinical practice in Canada is unknown.
PURPOSE: The primary purpose of this equivalence study was to compare the relative improvement in physical HRQoL after surgery for focal lumbar spinal stenosis (FLSS) compared with TJA for hip and knee osteoarthritis (OA) across six Canadian centers.
STUDY DESIGN/SETTING: A Canadian multicenter ambispective cohort study.
PATIENT SAMPLE: A cohort of 371 primary one- to two-level spinal decompression (n=214 with instrumented fusion) for FLSS (n=179 with degenerative lumbar spondylolisthesis [DLS]) was compared with a cohort of primary total hip (n=156) and knee (n=208) arthroplasty for OA.
OUTCOME MEASURES: The primary outcome was the change in preoperative to 2-year postoperative 36-Item Short Form Health Survey Physical Component Summary (PCS) score as reflected by the number of patients reaching minimal clinically important difference (MCID) and substantial clinical benefit (SCB).
METHODS: Univariate analyses were conducted to identify baseline differences and factors that were significantly related to outcomes at 2 years. Multivariable regression modeling was used as our primary analysis to compare outcomes between groups.
RESULTS: The mean age (years) and percent females for the spine, hip, and knee groups were 63.3/58.5, 66.0/46.9, and 65.8/64.3, respectively. All three groups experienced significant improvement of baseline PCS (p<.001). Multivariate analyses, adjusting for baseline differences (age, gender, baseline Mental Component Summary score, baseline PCS), demonstrated no significant differences in PCS outcome between spinal surgery and arthroplasty (combined hip and knee cohorts) patients with an odds ratio of 0.80 (95% confidence interval [CI], 0.57-1.11; p=.17) and 0.79 (95% CI, 0.58-1.09; p=.15) for achieving MCID or SCB, respectively. In subgroup analysis, spine and knee outcomes were not significantly different, with hip arthroplasty superior to both (p<.0001).
CONCLUSIONS: Significant improvement in physical HRQoL after surgical treatment of FLSS (including DLS) is consistently achieved nationally. Our overall results demonstrate that a comparable number of patients can expect to achieve MCID and SCB 2 years after surgical intervention for FLSS and total knee arthroplasty.

PMID: 22122836 [PubMed – in process]

Delayed Formation of a Devastating Granulomatous Process after Metal-to-Metal Lumbar Disc Arthroplasty.

Spine (Phila Pa 1976). 2011 Nov 14;

Authors: Cabraja M, Schmeding M, Koch A, Podrabsky P, Kroppenstedt S

ABSTRACT: Study Design. Case report.Objective. We report the case of a female patient with a delayed and devastating complication after lumbar total disc arthroplasty (TDA).Summary of Background Data. The formation of granulomatous tissue surrounding arthroplasty devices has been described following hip replacements, but has been reported only in two cases following spinal surgery: In one case the patient improved after removal of the cervical metal-to-metal device and in another case the soft tissue surrounding the TDA-device stopped growing after posterior fixation of the lumbar segment.Methods. Retrospective case study of a female patient with a delayed complication after lumbar TDA with a metal-to-metal-device for degenerative disc disease at level L4-5 and with follow-up examination 8 months after surgery.Results. About 11 months after lumbar arthroplasty surgery the patient developed back pain and progressive weakness of both legs. A CT scan revealed soft tissue surrounding the TDA device and infiltrating the spinal canal. The revision surgery (posterior fixation and decompression) did not improve the clinical situation. The progressive growth of soft tissue lead to a high grade paraparesis and occlusion of the left ureter as well as of both common iliac veins and of the infrarenal part of the vena cava inferior.The TDA device was removed. Another posterior surgery with extensive instrumentation was necessary to treat a destruction of vertebral bodies L4 and L5 two months after the last surgery.The histopathological analysis revealed a granulomatous necrotizing inflammation. After the last revision surgery the patient’s back pain decreased. At her last follow-up no further growth of the soft tissue mass could be found.Conclusions. Metal-to-metal TDA devices can induce a tumor-like growth with devastating consequences. The reduction of device motion by posterior stabilizing surgery does not seem to stop the growth of the granulomatous mass. The device has to be removed.

PMID: 22089396 [PubMed – as supplied by publisher]

Biomechanical Comparison of Lumbar Total Disc Arthroplasty, Discectomy and Fusion: Effect on Adjacent-Level Disc Pressure and Facet Joint Force.

Spine (Phila Pa 1976). 2011 Aug 18;

Authors: Gao SG, Lei GH, Liu H, Xiao WF, Wen T, Liang JY, Li KH

ABSTRACT: Study Design. An in vitro human cadaveric biomechanical study.Objective. To compare adjacent-level intradiscal pressures (IDPs) and facet joint stresses among lumbar total disc arthroplasty (TDR), discectomy and fusion.Summary of Background Data. With increasing advocacy for the use of TDR procedure as a potential alternative to fusion in the management of lumbar degenerative disc disease, IDPs and facet joint stresses at the adjacent levels of spine have generated considerable interest.Methods. Ten fresh human cadaveric lumbar specimens (L2-S1) were subjected to unconstrained load in axial torsion (AT), lateral bending (LB), flexion (F) and extension (E) using multidirectional flexibility test. Four surgical treatments-intact, discectomy, TDR and fusion at L4-L5 were tested in sequential order. During the test, IDPs and facet forces of each treatment were calculated at adjacent levels (L5-S1).Results. Similar IDPs and facet force pressure were recorded between the intact condition and a TDR reconstruction at adjacent levels under all loading modes (P>0.05). Compared to the intact and disc replacement groups, discectomy or fusion groups had higher adjacent-level IDPs under all loading conditions (P<0.05). No significant difference of the L5-S1 facet force pressure was noted among the intact, discectomy and the total disc replacement group under any loading conditions (P>0.05). However, the L5-S1 facet force pressure produced under all loading modes for fusion was significantly higher than the means obtained for the intact, discectomy and disc replacement groups (P<0.05).Conclusion. Lumbar total disc arthroplasty maintain adjacent-level IDPs and facet force pressure near the values of the intact spines, but with respect to adjacent-level IDPs tended to increase after discectomy or fusion and facet force tended to raise after fusion.

PMID: 21857405 [PubMed – as supplied by publisher]

Continuous versus single-injection lumbar plexus blocks: comparison of the effects on morphine use and early recovery after total knee arthroplasty.

Reg Anesth Pain Med. 2005 Nov-Dec;30(6):541-7

Authors: Watson MW, Mitra D, McLintock TC, Grant SA

Continuous lumbar plexus infusion of local anesthetic after total knee arthroplasty has been shown to improve analgesia and early recovery as compared with patient-controlled analgesia (PCA) morphine. Any benefit of an infusion over a single-injection lumbar plexus block has not been directly shown however.

PMID: 16326339 [PubMed – indexed for MEDLINE]

A large lumbar hernia presenting as a flank mass after total hip arthroplasty.

J Arthroplasty. 2001 Dec;16(8):1078-80

Authors: Steinfeld R, Trousdale RT, Farley DR

Soft tissue swelling occasionally can be seen about the incision after a total hip arthroplasty. We report a case of a lateral wall hernia occurring immediately after a total hip arthroplasty that presented as a mass over the proximal aspect of the hip incision.

PMID: 11740768 [PubMed – indexed for MEDLINE]

Biomechanics of lumbar arthroplasty.

Neurosurg Clin N Am. 2005 Oct;16(4):595-602, v

Authors: Crawford NR

There are many issues to consider in evaluating the biomechanics of lumbar arthroplasty, which may consist of a nucleus replacement, a total disc replacement, or a mobile posterior device. The goal of spinal arthroplasty is to replicate or augment the function of the normal spinal elements, by taking into consideration both in the quantity and quality of motion that occurs across the replaced joint. This article describes the relevant parameters for studying the biomechanics of lumbar arthroplasty and briefly summarizes the current knowledge with regard to those parameters in some well-known lumbar nucleoplasty, facet replacement, and total disc arthroplasty devices.

PMID: 16326282 [PubMed – indexed for MEDLINE]

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