166. Lumbar total disc replacement as a part of adult scoliosis surgical treatment of 205 patients with minimum of 2 years of follow-up

• Published in: The spine journal 2021-09, Vol.21 (9), p.S83-S83
• Main Author: Marnay, Thierry P.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.05.194

Surgical scoliosis treatment in adults must face beyond the curve correction, degeneration disc disease, dislocations, spondylolisthesis with sagittal and frontal unbalance and lumbar kyphosis. Two technical components of the surgery have been used to resolve those difficult problems: the fixation through the pelvis, with a complete loss of lumbar mobility and its consequences. The higher rate of pseudarthrosis, despite complex contracts, on one hand, and the necessity of posterior lumbar osteotomies to restore an acceptable lordosis with severe risk of complications on the other hand. To explore the capacity to maintain or restore part of mobility and lumbar lordosis, using total disc replacement TDR), by anterior approach (with or without ALIF) in association with the posterior reduction, fixation. Retrospective clinical study. A total of 205 patients, 40M, 165F, 18-82 year old (average age 57 yo). Of these, 112 idiopathic scoliosis never operated before, 43 degenerative scoliosis in adults never operated on, and 50 cases already operated on by posterior approach (below prior surgery). A total of 286 TDR Prodisc were implanted (129 - 1 level, 71 - 2 levels, 5 – 3 levels). The patients’ analysis includes the perioperative, preop and postop VAS and ODI (3, 6, 12, 24, late follow-up), mobility of the disc replacement and the evolution of the curve (Cobb, sagittal parameters). Between 2000 and 2018, 123 patients with scoliosis and lumbar disc degeneration have received one or more TDR and eventually ALIF, before or after their posterior fixation reduction. The posterior device associated classically hooks, screws, and the rods. The choice of the TDR is one of the key points as with the deformity, there is a need for semi-constrained (fixed center) prosthesis, to neutralize the shear forces and compensate the deficit of anterior and posterior longitudinal ligaments. ODI preop was 24/50 and declined to 10 in 24 months, VAS lumbar 7.2, radicular 5.7 prep went to 2.6 and 2.1 at 24 months and stabilized at latest follow-up. The mobility measurement at 24 months showed: 151 of 205 patients had a ROM at the TDR level more than 10° in flexion-extension at 24 months. The lordosis capacity of the implants eventually associated to and ALIF with appropriated angulation, allowed the sagittal balance restoration, with T1 axe correction and pelvic tilt reduction. There were no major complications, 4 anterior hematomas (2 drainages, 2 surgical treatments), 2 partial neurolo