Байкальский медицинский журнал (Sep 2024)
A LONG-TERM OUTCOMES OF LUMBAR DISK ARTHROPLASTY AND LUMBAR INTERBODY FUSION IN SURGICAL TREATMENT OF LUMBAR INTERVERTEBRAL DISK DEGENERATIVE DISEASE: A SYSTEMATIC REVIEW
Abstract
Relevance. Patients with long-standing discogenic low back pain who do not show clinical improvement after conservative treatment are referred for surgical treatments such as lumbar fusion or total disc arthroplasty.The purpose –– to evaluate the long-term effectiveness and safety of total intervertebral disc arthroplasty (TDA) and lumbar interbody fusion (LIF) in patients with degenerative lumbar intervertebral disk disease.Material and methods. A comprehensive literature search strategy was developed in the PubMed/Medline and Cochrane Central Register of Randomized Controlled Trials databases. Studies were searched between January 2005 and May 2024 without restrictions on level of evidence or publication status. Both English-language articles and domestic publications were analyzed.Results. The systematic review included four randomized controlled trials covering the long-term outcomes of surgical treatment of 1325 patients with degenerative lumbar intervertebral disk disease. There are no differences in the operating time in the total intervertebral disc arthroplasty and lumbar interbody fusion groups. In the lumbar interbody fusion group, the volume of blood loss exceeded that in the total intervertebral disc arthroplasty group of intervertebral disks. There were no differences between the total intervertebral disc arthroplasty and lumbar interbody fusion groups in the severity of low back pain on the visual analogue scale. In the total intervertebral disc arthroplasty group, the level of patient disability according to the Oswestry Disability Index is on average 9 % higher than in the lumbar interbody fusion group. The percentage of satisfaction with the operation in the group of patients after total intervertebral disc arthroplasty exceeds this indicator in the group of patients who underwent lumbar interbody fusion. The analysis of the incidence of complications demonstrated the absence of differences between the compared techniques. The frequency of reoperations in the total intervertebral disc arthroplasty group of intervertebral disks at the lumbar level is 48 % less than that in the lumbar interbody fusion group.Conclusion. The obtained clinical results of total intervertebral disc arthroplasty of intervertebral disks at the lumbar level with preservation of the range of motion of the operated segment and the entire lumbar spine suggest that this technique is a promising alternative to lumbar interbody fusion.
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