Lumbar interbody replacement recurrence rate

People of the older generation always say that people must protect their waists. If the waist is damaged, everything will be damaged. This makes sense because the lumbar spine is very important to us. If there is a problem with the lumbar spine, it means that the patient needs to undergo artificial lumbar replacement. After the operation, everyone will worry about the chance of recurrence.

Artificial disc replacement can overcome the disadvantages of discectomy and spinal fusion, and the follow-up results in the past 10 years are relatively satisfactory. However, whether it can meet people's expectations for this technology - to be used for 40 years - still requires long-term follow-up. Current studies suggest that complications of artificial intervertebral disc prostheses, in addition to vascular injury, retrograde ejaculation, and deep vein thrombosis related to anterior approach surgery, include short-term complications related to implants, including poor prosthesis positioning, liner dislocation, displacement, vertebral fractures, and postoperative radicular pain, and their occurrence is closely related to surgical techniques, prosthesis design, and case selection. Long-term complications related to implants include mechanical failure of prosthetic materials, osteolysis, prosthesis subsidence, and progressive facet arthritis.

With the continuous improvement of prosthesis design technology and materials, the mechanical failure of the material itself can be avoided to a large extent, but prosthesis subsidence caused by osteolysis is a more important reason for the long-term failure of total disc replacement. Same as hip and knee replacements. Osteolysis is a major problem after long-term implantation.

Since total disc replacement is essentially a half-joint replacement, the load pattern of the facet joints at the back of the spine will inevitably be affected, making it prone to progressive facet arthritis. Highly restrictive prostheses may play a certain role in preventing facet arthritis.

Total disc replacement, as a new technology, is more in line with the physiological environment of the human body. Therefore, with the continuous improvement of related supporting technologies, total disc replacement may replace intervertebral fusion and become the new "gold standard" for treating disc-related low back pain. However, there is currently insufficient evidence to prove that its efficacy is better than intervertebral fusion, and the scope of application of total disc replacement is significantly smaller than that of intervertebral fusion. The final result can only be answered by evidence-based medicine.

Appendix: Guidelines for low back pain treatment methods (proposed by the American JBJS in 2004, for reference only due to different national conditions)

1. Early treatment methods

(1) Drugs: ① NSAIDs; ② Acetaminophen; ③ Muscle relaxants; ④ Anesthetics (short-term).

(2) Short-term bed rest (no more than 2 days).

(3) Physical therapy.

(4) Massage therapy.

2. Late treatment methods

(1) Medication: Antidepressants.

(2) Brace treatment.