Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results
Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications. 1. Introduction Currently, one of the most important causes of chronic low back pain is thought to be a painful disc [1–3]. Some biomechanical and biochemical changes play a role in intervertebral disc degeneration; on the other hand intrinsic, extrinsic, and genetic factors are also important. Compression of the spine, torsional injuries, overload, and congenital anomalies have been shown to contribute to disc degeneration with applying excessive pressure onto intervertebral discs [4–10]. Despite numerous research studies, the etiology and physiopathology of disc degeneration remain unknown [2]. Annular tears resulting from degeneration of the annulus fibrosis, that contains pain receptors and internal disc ruptures, are the most common cause of pain [11–13]. Today, it is believed that degenerative disc disease (DDD) might cause instability in spine segments, and it is widely accepted that progressive back pain results due to this instability [14–16]. In fact, segmental instability begins when disc height deterioration is initiated by the progression of intervertebral disc degeneration. Instability as a consequence of disc degeneration has been described by Frymoyer [14, 15] as primary segmental
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