A LONG-TERM OUTCOMES OF LUMBAR DISK ARTHROPLASTY AND LUMBAR INTERBODY FUSION IN SURGICAL TREATMENT OF LUMBAR INTERVERTEBRAL DISK DEGENERATIVE DISEASE: A SYSTEMATIC REVIEW

Relevance. Patients with long-standing discogenic low back pain who do not show clinical improvement after conservative treatment are referred for surgical treatments such as lumbar fusion or total disc arthroplasty.

The purpose –– to evaluate the long-term effectiveness and safety of total intervertebral disc arthroplasty (TDA) and lumbar interbody fusion (LIF) in patients with degenerative lumbar intervertebral disk disease.

Material and methods. A comprehensive literature search strategy was developed in the PubMed/Medline and Cochrane Central Register of Randomized Controlled Trials databases. Studies were searched between January 2005 and May 2024 without restrictions on level of evidence or publication status. Both English-language articles and domestic publications were analyzed.

Results. The systematic review included four randomized controlled trials covering the long-term outcomes of surgical treatment of 1325 patients with degenerative lumbar intervertebral disk disease. There are no differences in the operating time in the total intervertebral disc arthroplasty and lumbar interbody fusion groups. In the lumbar interbody fusion group, the volume of blood loss exceeded that in the total intervertebral disc arthroplasty group of intervertebral disks. There were no differences between the total intervertebral disc arthroplasty and lumbar interbody fusion groups in the severity of low back pain on the visual analogue scale. In the total intervertebral disc arthroplasty group, the level of patient disability according to the Oswestry Disability Index is on average 9 % higher than in the lumbar interbody fusion group. The percentage of satisfaction with the operation in the group of patients after total intervertebral disc arthroplasty exceeds this indicator in the group of patients who underwent lumbar interbody fusion. The analysis of the incidence of complications demonstrated the absence of differences between the compared techniques. The frequency of reoperations in the total intervertebral disc arthroplasty group of intervertebral disks at the lumbar level is 48 % less than that in the lumbar interbody fusion group.

Conclusion. The obtained clinical results of total intervertebral disc arthroplasty of intervertebral disks at the lumbar level with preservation of the range of motion of the operated segment and the entire lumbar spine suggest that this technique is a promising alternative to lumbar interbody fusion.

1. Yu L, Wang X, Lin X, Wang Y. The Use of Lumbar Spine Magnetic Resonance Imaging in Eastern China: Appropriateness and Related Factors. PLoS One. 2016;11(1):e0146369. doi:10.1371/journal.pone.0146369.

2. Akeda K, Yamada T, Inoue N, Nishimura A, Sudo A. Risk factors for lumbar intervertebral disc height narrowing: a population-based longitudinal study in the elderly. BMC Musculoskelet Disord. 2015;16:344. doi:10.1186/s12891-015-0798-5.

3. Yan YZ, Li QP, Wu CC, et al. Rate of presence of 11 thoracic vertebrae and 6 lumbar vertebrae in asymptomatic Chinese adult volunteers. J Orthop Surg Res. 2018;13(1):124. doi:10.1186/s13018-018-0835-9.

4. Lee YC, Zotti MG, Osti OL. Operative Management of Lumbar Degenerative Disc Disease. Asian Spine J. 2016;10(4):801-19.

5. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18.

6. Beatty S. We Need to Talk about Lumbar Total Disc Replacement. Int J Spine Surg. 2018;12(2):201-240. doi:10.14444/5029.

7. Бывальцев В.А., Калинин А.А., Пестряков Ю.Я., Шепелев В.В., Степанов И.А. Анализ результатов применения тотальной артропластики межпозвонкового диска пояснично-крестцового отдела позвоночника протезом М6-L: мультицентровое исследование. Вестник Российской академии медицинских наук. 2017;72(5):393-402. doi:10.15690/vramn782.

8. Formica M, Divano S, Cavagnaro L, et al. Lumbar total disc arthroplasty: outdated surgery or here to stay procedure? A systematic review of current literature. J Orthop Traumatol. 2017;18(3):197-215. doi:10.1007/s10195-017-0462-y.

9. Salzmann SN, Plais N, Shue J, Girardi FP. Lumbar disc replacement surgery-successes and obstacles to widespread adoption. Curr Rev Musculoskelet Med. 2017;10(2):153-59. doi:10.1007/s12178-017-9397-4.

10. Hoff E, Strube P, Pumberger M, Zahn RK, Putzier M. ALIF and total disc replacement versus 2-level circumferential fusion with TLIF: a prospective, randomized, clinical and radiological trial. Eur Spine J. 2016;25(5):1558-1566. doi: 10.1007/s00586-015-3852-y.

11. Sköld C, Tropp H, Berg S. Five-year follow-up of total disc replacement compared to fusion: a randomized controlled trial. Eur Spine J. 2013;22(10):2288-95. doi: 10.1007/s00586-013-2926-y.

12. Berg S, Tullberg T, Branth B, Olerud C, Tropp H. Total disc replacement compared to lumbar fusion: a randomized controlled trial with 2-year follow-up. Eur Spine J. 2009;18(10):1512-9.

13. Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D. Clinical Outcomes of Total Disc Replacement Versus Anterior Lumbar Interbody Fusion for Surgical Treatment of Lumbar Degenerative Disc Disease. Global Spine J. 2017;7(5):452-59. doi: 10.1177/2192568217712714.

14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):1-34. doi:10.1016/j.jclinepi.2009.06.006.

15. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1-12.

16. Gornet MF, Dryer RF, Peloza JH, Schranck FW. Lumbar disc arthroplasty vs. anterior lumbar interbody fusion: five-year outcomes for patients in the Maverick® disc IDE study. Spine J. 2010;10:64. doi:10.1016/j.spinee.2010.07.174.

17. Guyer RD, McAfee PC, Banco RJ, et al. Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: five-year follow-up. Spine J. 2009;9:374-86. doi: 10.1016/j.spinee.2008.08.007.

18. Zigler JE. Five-year results of the ProDisc-L multicenter, prospective, randomized, controlled trial comparing ProDisc-L with circumferential spinal fusion for single-level disabling degenerative disk disease. Semin Spine Surg. 2012;24:25-31. doi:10.1053/j.semss.2011.11.006.

19. Wei J, Song Y, Sun L, Lv C. Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials. Int Orthop. 2013;37(7):1315-25. doi:10.1007/s00264-013-1883-8.

20. Zigler J, Gornet MF, Ferko N, Cameron C, Schranck FW, Patel L. Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials. Global Spine J. 2017;8(4):413-23. doi:10.1177/2192568217737317.

21. Бывальцев В.А., Степанов И.А., Пестряков Ю.Я. Возможности диффузионно-взвешенной МРТ в оценке степени дегенерации смежного межпозвонкового диска: ригидная пояснично-крестцовая стабилизация и тотальная артропластика межпозвонковых дисков. Вестник травматологии и ортопедии имени Н.Н. Приорова. 2017;(4):18-24. doi:10.32414/0869-8678-2017-4-18-24.

22. Garcia R Jr, Yue JJ, Blumenthal S, Coric D, Patel VV, Leary SP, et al. Lumbar Total Disc Replacement for Discogenic Low Back Pain: Two-year Outcomes of the activL Multicenter Randomized Controlled IDE Clinical Trial. Spine (Phila Pa 1976). 2015;40(24):1873-81. doi:10.1097/brs.0000000000001245.

23. Бывальцев В.А., Пестряков Ю.Я., Шепелев В.В., Степанов И.А. Влияние гетеротопической оссификации на клинические и рентгенологические исходы после тотальной артропластики поясничных межпозвонковых дисков протезом «M6-L»: мультицентровое исследование. Хирургия позвоночника. 2017;14(4):9-15. doi:10.14531/ss2017.4.69-75.

24. Agarwal S, Loder SJ, Brownley C, Eboda O, Peterson JR, Hayano S, Wu B, Zhao B, Kaartinen V, Wong VC, Mishina Y, Levi B. BMP signaling mediated by constitutively active Activin type 1 receptor (ACVR1) results in ectopic bone formation localized to distal extremity joints. Dev Biol. 2015;400:202-09. doi:10.1016/j. ydbio.2015.02.011.

25. Convente MR, Wang H, Pignolo RJ, Kaplan FS, Shore EM. The immunological contribution to heterotopic ossification disorders. Curr Osteoporos Rep. 2015;13:116-24. doi:10.1007/s11914-015-0258-z.

26. Suzuki H, Ito Y, Shinohara M, Yamashita S, Ichinose S, Kishida A, Oyaizu T, Kayama T, Nakamichi R, Koda N, Yagishita K, Lotz MK, Okawa A, Asahara H. Gene targeting of the transcription factor Mohawk in rats causes heterotopic ossification of Achilles tendon via failed tenogenesis. Proc Natl Acad Sci USA. 2016;113:7840-45. doi: 10.1073/pnas.1522054113.

27. Rao MJ, Cao SS. Artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2014;134(2):149-58. doi:10.1007/s00402-013-1905-4.