Not all patients achieve adequate relief from back pain after lumbar total disc replacement (TDR). In patients with device failure, including disc dislocation, revision surgery via anterior approaches and disc replacement is indispensable. However, the best treatment for patients with well-placed prostheses but persistent pain remains unclear. Here, we evaluated the option of lumbar transpedicular fixation at the index level in patients who did not achieve adequate pain relief after TDR without evidence of device failure.
Four patients (mean age, 47 years) presented with persistent low back pain for 12-24 months (mean, 16.3) after lumbar TDR. No device failures were observed. All patients underwent transpedicular fixation at the index level. Clinical outcome was assessed via the Oswestry disability index, a visual analog scale, and recording of the consumption of analgesic.
No postoperative complications were observed. The average follow-up after lumbar transpedicular fixation was 53.5 months (range, 43-80). Two patients considered the outcome as excellent, one as good, and one as poor. The mean visual analog scale pain score decreased from 7.8 (range, 7-8) to 4.3 (range, 2-8). The mean Oswestry disability index decreased from 43.5 (range, 39-47) to 27.5 (range, 14-47). At the last follow-up, one patient was without analgesic medication and substitution of opiates with non-opioid analgesics was possible in two patients.
In patients with persistent low back pain after TDR without device failure or adjacent segment pathologies, lumbar transpedicular fixation without removal of the disc prosthesis may be a useful therapeutic option.