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Lumbar total disc replacement: predictors for long-term outcome

Permanent lenke
https://hdl.handle.net/10037/14150
DOI
https://doi.org/10.1007/s00586-017-5375-1
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Åpne
article.pdf (779.4Kb)
accepted manuscript version (PDF)
Dato
2017-11-04
Type
Journal article
Tidsskriftartikkel
Peer reviewed

Forfatter
Furunes, Håvard; Hellum, Christian; Brox, Jens Ivar; Rossvoll, Ivar; Espeland, Ansgar; Berg, Linda; Brøgger, Helga Maria; Småstuen, Milada C; Storheim, Kjersti
Sammendrag
Purpose: We aimed to identify patient characteristics associated with favourable long-term outcomes after lumbar total disc replacement (TDR).
Methods: We analysed a cohort of 82 patients with degenerative disc and chronic low back pain (LBP) who were treatedwith TDR and originally participated in a randomised trial comparing TDR and multidisciplinary rehabilitation. Potential predictors were measured at baseline, and the outcomes assessed 8 years after they received allocated treatment. Outcome measures were dichotomised according to whether the participants achieved a clinically important functional improvement (15 points or more on the Oswestry Disability Index, ODI) (primary outcome) and whether they were employed at 8-year follow-up (secondary outcome). Associations between potential predictors and outcomes were modelled using logistic regression. For the secondary outcome, the results were also organised in a prediction matrix and expressed as probabilities.
Results: For 71 patients treated with TDR according to protocol, the follow-up time was 8 years. For a subgroup of 11 patients randomised to rehabilitation who crossed over and received TDR, the median postoperative follow-up time was 72 (range 41–88) months. Of all assessed baseline variables, only presence of Modic changes (type 1 and/or 2) was statistically signifcantly associated with an improvement of ≥ 15 ODI points. The probability of employment at 8-year follow-up was 1% for patients with ≥ 1 year of sick leave, comorbidity, ODI ≥ 50 and ≤ 9 years of education prior to treatment, and 87% for patients with < 1 year of sick leave, no comorbidity, ODI < 50 and higher education.
Conclusions: Patients with Modic changes prior to the TDR surgery were more likely to report a clinically important functional improvement at long-term follow-up. Comorbidity, low level of education, long-term sick leave and high ODI score at baseline were associated with unemployment at long-term follow-up.
Forlag
Springer Nature
Sitering
Furunes, H., Hellum, C., Brox, J.I., Rossvoll, I., Espeland, A., Berg, L., ... Storheim K. (2017). Lumbar total disc replacement: predictors for long-term outcome. European spine journal, 27, Issue 3, 709–718. https://doi.org/10.1007/s00586-017-5375-1
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  • Artikler, rapporter og annet (klinisk medisin) [1974]

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