Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

INTRODUCTION: Lumbar total disc replacement (TDR) has been found to be a viable alternative to fusion in appropriately selected patients. In many studies, patients are excluded if they have had prior fusion and though not generally a formal exclusion criteria, there appears to be reluctance to do TDR in patients with multiple prior discectomies. The concern is that the prior surgery may have created instability of the posterior elements, potentially compromising the safety and/or function of TDR. The purpose of this study was to evaluate outcomes of TDR in patients with symptomatic disc degeneration who have undergone multiple discectomies at the index level.

METHODS: This study was a review of patients undergoing TDR at a single institution. Records of TDR patients were reviewed and a consecutive series of  112 patients who had multiple previous discectomies at the surgical level were identified. Age, body mass index (BMI) were recorded. Outcome assessment included visual analog scales separately assessing low back and leg pain, and  Oswestry Disability Index (ODI) scores were recorded preoperatively and postoperatively to evaluate changes. Re-operations were also recorded.

RESULTS: Of the 112 patients (34 females, 78 males) the average age was 42.9+9.6 years, and body mass index (BMI) was 27.9±4.4 kg/m². The mean follow-up was 17.1 months. Prior discectomy at the TDR level had been performed twice in 98 (87.5%) patients 3 times in the remaining 14 (12.5%) patients. There was statistically significant improvement in VASback pain, VASleg pain, and ODI scores, all p<0.001 (Table 1). The mean scores improved by more than 50% on all 3 measures. Of the 112 surgeries, there were 5 reoperations (4.5%). These included a facet cyst removal at the level above the TDR at 144 months postop, a 2-level decompression for stenosis above the TDR at a remote facility at an unknown timepoint, and 3 due to symptomatic adjacent segment degeneration performed at 16, 29, and 199 months post-TDR.

DISCUSSION: The results of this study found statistically significant improvement in low back and leg pain as well as self-reported disability following TDR in patients with multiple previous discectomies at the same level. Of note, none of the re-operations were performed at the TDR level, indicating no problems with structural integrity related to the motion preserving devices. Patients with multiple prior discectomies merit careful evaluation of the posterior elements prior to TDR to assess for adequate stability to support motion preservation. Provided this is present, the current study supports lumbar TDR is a viable alternative to fusion in these patients.