RT Journal Article
SR Electronic
T1 Physical capability outcomes after total disc replacement with ProDisc-L
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 43
OP 48
DO 10.1016/j.ijsp.2011.11.001
VO 6
A1 Humbert G. Sullivan
A1 Robert L. Bobenmoyer
A1 Kevin M. Boland
A1 Molly M. Cerniglia
A1 Vicki L. McHugh
A1 Hayley L. Born
A1 Michelle A. Mathiason
A1 Nicholas R. Ladwig
YR 2012
UL http://ijssurgery.com//content/6/43.abstract
AB Background Lumbar disc arthroplasty (total disc replacement [TDR]) outcomes have been evaluated using subjective, patient-reported measures of pain, health, and functional impairment. As a condition of TDR coverage, our institution's health plan required that objective physical performance data be collected. Thus our study was designed to explore (1) the feasibility of using preoperative and 1-year postoperative performance on functional capacity tasks as an outcome metric for TDR with ProDisc-L (PD-L) (Synthes Spine, West Chester, Pennsylvania), (2) the magnitude and significance of changes in preoperative and postoperative performance, and (3) whether changes noted in performance are reflected in the subjective measures.Methods Seven adapted WorkWell tasks (physical capability assessment tool [PCAT]) (WorkWell Systems, Duluth, Minnesota) were performed preoperatively and 1 year postoperatively by 18 patients who received either single-level or 2-level PD-L implants. Demographic and medical data were reviewed.Results The PCAT was implemented easily, and the tasks took approximately 30 minutes to complete. Percent improvement and preoperative and postoperative physical capability outcomes for each PCAT task are as follows: squat, 79% (10.7 ± 7.1 repetitions vs 19.2 ± 2.0 repetitions, P &lt; .001); forward bend, 121% (110.2 ± 68.8 seconds vs 243.6 ± 77.2 seconds, P &lt; .001); kneel, 92% (283.2 ± 173.2 seconds vs 544.7 ± 109.3 seconds, P &lt; .001); floor-to-waist lift, 128% (16.1 ± 9.9 lb vs 36.7 ± 20.3 lb, P &lt; .001); horizontal carry, 119% (19.7 ± 8.6 lb vs 43.2 ± 18.3 lb, P &lt; .001); push, 32% (67.7 ± 19.2 lb vs 89.4 ± 24.4 lb, P &lt; .001); and pull, 40% (57.6 ± 17.1 lb vs 80.9 ± 26.4 lb, P &lt; .001). Visual analog scale scores for pain (5.1 ± 1.7 vs 1.4 ± 1.6, P &lt; .001), Oswestry Disability Index scores (49.0% ± 13.2% vs 15.2% ± 14.3%, P &lt; .001), and amount of narcotic use (26.1 ± 43.8 mg of morphine equivalent vs 1.9 ± 7.3 mg of morphine equivalent, P = .031) also improved. In single-level cases, comparison of L4-5 versus L5-S1 showed significant differences only with the forward bend task (P = .002).Conclusions/Clinical Relevance The physical capability outcome may be a feasible outcome metric. PD-L implantation may result in substantial improvements in physical performance. Similar benefits shown in a larger series over a longer timeframe could have important implications for the long-term health, productivity, and cost of health care for this patient population.