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Poster: 23Lumbar Disc Replacement. an 11-Years Experience.*Matteo Formica - Universita Di Genova - Genova, ItalyCarlo Formica - - Bogliasco,*Email: matteoformica@hotmail.itLUMBAR DISC REPLACEMENT. AN 11-YEARS EXPERIENCE.INTRODUCTIONThe treatment of low back pain due to a disc pathology has been changed in the last yearsthanks to the improvement of the biomechanical knowledge and therefore to the role of theintervertebral disc in the segment of motion. However prosthesis and instrumentations have hadimportant improvements. Arthrodesis is still a diffused technique in vertebral surgery but theoverloading of the discs above and below is a common complication. The segment of motionpreservation is becoming imperative not only in young patients.MATERIAL AND METHODSFrom November 1998 to March 2009 we implanted 92 lumbar disc prosthesis in 88 patients. 70were females and 18 males. The minimum age was 21 years old and the maximum 60 years old.The average was 40. We have never treated patients over 60 years old neither patients with poorsubcondral bone quality. Most of the cases were primitive lumbar disc degeneration, only 14 ofthe patients treated were suffering for low back pain and radicular pain after previous surgery.In 8 cases the levels were L3L4, in 59 L4L5 and in 25 L5S1. In 4 patients we performed a 2level disc replacement. Charitè was used in 4 cases, Prodisc in 12 and Maverick in theremaining 76 cases (64 frontal and 12 oblique implants). The follow up starts from a minimumof 3 months to a maximum of 11 years and 6 months.RESULTSVAS and Oswestry disability index were used to evaluate the clinical outcomes. In 95% of thecases we had excellent results with the remission of the symptoms. We had 3 cases ofabdominal muscles paresis and 1 of these underwent an abdominal plastic reconstruction. In 4patients we had a paravertebral simpatic suffering with an alteration of the thermical sensibilityof the lower limb. One male patient developed an irritation of the sacral plexus with an inverseeiaculation. In only 6 cases a radiological asymmetric positioning was found, even if withoutsymptoms. There was an important remission of the radicular pain in the 14 cases of secondarysurgery. The complications might have been linked to the first operations since we never havefound them in the most recent cases. The weight bearing was allowed the day after surgery withan abdominal bandage. In most of the patients the feeling of an important and immediateclinical changing was found. All of the patients returned back to work and practicing sports.CONCLUSIONSWe consider that the prosthesis with a fixed metal on metal insert are easier to handle especiallyconsidering the surgical implantation technique, furthermore the one with the oblique insertionallows a less invasive mobilization of the iliac vessels above all approaching L4L5. Despite thisis an apparent invasive surgery, all of the patients were able to walk the day after the operationand they were discharged after 2 or 3 days. We are very satisfied of this technique, even if asevere selection of the patients and a long learning curve is requested.Figuresfile:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]