OBJECTIVE: The objective of this study was to determine whether lumbar disc replacement (LDR) can provide radiographic indirect decompression as effectively as anterior lumbar interbody fusion (ALIF).
SUMMARY OF BACKGROUND DATA: Isolated lumbar foraminal stenosis can often be treated with indirect decompression via ALIF. More recently, LDR has emerged as a motion-preserving treatment option for lumbar disease; however, its ability to provide indirect decompression has not been studied.
METHODS: All patients undergoing 1-level ALIF and LDR over a 7-year period were queried. A propensity-matched cohort was then identified utilizing patient-specific factors. This yielded 23 patients undergoing LDR and 44 undergoing ALIF. The primary outcome of this study was the change in radiographic foraminal height (FH) and segmental lordosis (SL) from pre- to postoperatively. All measurements were performed by 2 independent reviewers, and intraclass correlation coefficients (ICC) were calculated. Patient-reported outcome measures, including visual analog scale (VAS) back and leg scores, were collected for comparison at early and late postoperative timepoints. Intercohort comparisons were performed via Mann-Whitney U tests. P-values <0.05 were deemed significant.
RESULTS: Patients undergoing LDR had shorter operative time (98.9 vs. 136.7 min, P<0.01). FH and SL showed good ICCs (>0.75) across both reviewers. Preoperatively, ALIF patients had smaller radiographic FH (13.8 vs. 15.6 mm, P=0.01), but no other differences were seen. Both ALIF and LDR provided significant increases in FH (ALIF: 3.5 mm and LDR: 3.7 mm) and SL (ALIF: 8.0 degrees and LDR: 8.0 degrees). There were no differences in the mean ΔFH (P=0.56) or ΔSL (P=0.85) between cohorts. Both groups showed significant improvement in postoperative VAS leg scores at early and late time points.
CONCLUSIONS: LDR can provide indirect decompression and segmental lordosis restoration as effectively as ALIF.
STUDY DESIGN: Propensity-matched retrospective cohort.
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