A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

Background contextEffective alternatives to lumbar fusion for degenerative conditions have remained elusive. Anterior total disc replacement does not address facet pathology or central/recess stenosis, resulting in limited indications. A posterior-based motion-preserving option that allows neural decompression, facetectomy, and reconstruction of the facets may a role.PurposeThe purpose was compare one-year patient-reported outcomes novel, all-posterior, joint (LTJR – replacing both joints) against transforaminal interbody (TLIF) warranting (degenerative spondylolisthesis, recurrent herniation, severe foraminal stenosis requiring removal, adjacent segment degeneration).Study design/settingA retrospective analysis prospectively collected data comparing LTJR patients TLIF at an academic teaching hospital.Patient sampleAnalysis conducted on 156 adult who were propensity matched 52 sample 208.Outcome measuresSelf-reported Oswestry Disability Index (ODI) Numeric Rating Scale (NRS) back leg pain compared preoperatively, 3 months 1 year after surgery.MethodsThe implant is replaces function implanted using bilateral approach with complete facetectomies. Adult undergoing either open analyzed. These included: grade disease, degeneration stenosis). Trauma, tumor, 2 higher spinal deformity, infection cases excluded. Propensity score matching performed ensure parity between cohorts. Multivariable regression analyses done 1-year results as measured by different standards assess procedure success.ResultsAt months, cohorts showed significant similar improvements ODI NRS pain. At year, cohort continued improvement pain, while group plateau ODI, In series three multivariable logistic regressions, shown provide 3.3 times greater odds achieving minimal clinical symptom state disability (ODI <20%, <2) 2.4 4.1 substantial benefit (18% reduction ODI) clinically important difference (30% TLIF.ConclusionsHere we present comparative first spine versus pathology. The wide discectomy, working replace preserve motion. TLIF. suggest decompression combined motion preservation this novel represent viable alternative treating certain conditions. prospective controlled trial under development further evaluate efficacy, safety, durability procedure.