STUDY DESIGN: Case series OBJECTIVE.: The aim of this study was to assess the patient reported outcome measures (PROMs) and patient satisfaction of multi-level lumbar total disc arthroplasty (TDA) for symptomatic multilevel degenerative disc disease (MLDDD).
SUMMARY OF BACKGROUND DATA: TDA has been shown to be safe and effective for the treatment of symptomatic single level degenerative disc disease (DDD). There is minimal PROMs data on the mid- to long-term outcomes of multi-level TDA constructs.
METHODS: Prospectively collected PROMs were analysed from patients receiving multi-level TDA for symptomatic MLDDD. Data was collected pre-operatively and post-operatively at 3, 6 and 12 months, then yearly. PROMs included patient satisfaction, Visual Analogue Score back and leg, Oswestry Disability Index and Roland Morris Disability Questionnaire.
RESULTS: 122 patients (77 males, 45 females) who had pre-operative and at least 24-month follow-up data were included. The average age was 42 ± 8.2 years (range 21-61) and mean follow-up 7.8 years (range 2-10). The majority received two level TDA, except two patients (1.6%) who received three level TDA. The two three-level TDA's were at the levels L3-4, L4-5 and L5-S1, while most two levels (n = 110, 90.2%) were at L4-5 and L5-S1; the remainder (n = 10, 8.2%) being at L3-4 and L4-5. Implants used were Charité (DePuy Spine, Raynham, MA, USA) in 119 patients (240 levels) and InMotion (DePuy Spine, Raynham, MA, USA) in 3 patients (6 levels). Improvement in pain and disability scores were both clinically and statistically significant (p < 0.001) and this improvement was sustained in those patients over the course of their follow-up. 92% of patients reported good or excellent satisfaction with treatment at final review.
CONCLUSIONS: Multi-level TDA constructs for MLDDD demonstrate favourable and sustained clinical outcomes at mid- to long-term follow-up.
LEVEL OF EVIDENCE: 4.