The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients
The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients
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DOI：
10.1097/01.brs.0000144829.57885.20
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发表时间：
2004-11-15
期刊：
影响因子：
3
通讯作者：
Cammisa, FP
中科院分区：
文献类型：
--
作者：
Huang, RC;Lim, MR;Cammisa, FP
研究设计.本文是对腰椎全椎间盘置换术（TDR）禁忌症流行病学的回顾性综述。在一组接受腰椎手术的患者中，确定腰椎全椎间盘置换术禁忌症的患病率。（P. C.）背景资料摘要。没有发表的报告记录了腰椎全椎间盘突出症禁忌症的流行率。我们对2002年9月至12月期间由一名外科医生进行腰椎手术的100例连续患者进行了回顾性分析。记录进行的手术和TDR禁忌症。TDR的禁忌症包括中央或侧隐窝狭窄、小关节炎、脊椎峡部裂或脊椎滑脱、髓核突出伴神经根病、脊柱侧凸、骨质疏松症和术后假关节或后部结构缺陷。患者分为融合组和非融合组。计算无TDR禁忌症的患者百分比。在100例患者中，56例接受融合术，44例接受非融合术。在融合组中，56/56例患者有TDR禁忌症。在非融合组中，11%（5/44）为TDR的候选者。总体而言，该系列中5%的患者是TDR的候选者。TDR禁忌症的平均数量为2.48（范围，0 - 5）。关于TDR将取代核聚变的预测还为时过早。目前在我们机构接受腰椎手术的患者中，有一小部分（5%）没有TDR禁忌症。TDR植入的未来增长将来自于今天不适用手术的患者的适应症或目前禁忌症的消除。
Study Design. This is a retrospective review of the epidemiology of contraindications to lumbar total disc replacement (TDR).Objective. To define the prevalence of contraindications to lumbar total disc replacement in a cohort of patients undergoing lumbar surgery in the senior author's ( F. P. C.) practice.Summary of Background Data. No published reports have documented the prevalence of contraindications to lumbar total disc replacement.Methods. We performed a retrospective review of 100 consecutive patients who had lumbar surgery by one surgeon between September and December 2002. Procedures performed and contraindications to TDR were recorded. Contraindications to TDR included central or lateral recess stenosis, facet arthrosis, spondylolysis or spondylolisthesis, herniated nucleus pulposus with radiculopathy, scoliosis, osteoporosis, and postsurgical pseudarthrosis or deficiency of posterior elements. Patients were divided into fusion and nonfusion groups. The percentage of patients without contraindications to TDR was calculated.Results. Of 100 patients, 56 had fusions and 44 had nonfusion surgery. In the fusion group, 56 of 56 patients had contraindications to TDR. In the nonfusion group, 11% ( 5 of 44) were candidates for TDR. Overall, 5% of patients in this series were candidates for TDR. The average number of contraindications to TDR was 2.48 ( range, 0 - 5).Conclusions. Predictions that TDR will replace fusion are premature. A small percentage ( 5%) of the patients currently indicated for lumbar surgery at our institution have no contraindications to TDR. Future growth in TDR implantation will result from the indication of patients for surgery who would not be indicated today or from the elimination of current contraindications.