Charité lumbar disc replacement shows good results at 10 years minimum follow-up

Investigator reports a 10.4% overall reoperation rate, including eight index-level posterior fusions out of 106 patients.

Most patients implanted with the Charité lumbar total disc arthroplasty prosthesis at a single level continue to show good functional outcomes at up to 16 years follow-up, according to a new study published in the journal Spine.

Thierry David, MD, an orthopedic spine surgeon at the Polyclinique De Bois Bernard in Rouvroy, France, retrospectively reviewed his results implanting the Charité disc [DePuy Spine, a Johnson & Johnson Company] in 108 patients. This includes 63 women and 45 men treated at an average age of 36.4 years. All patients had single-level lumbar degenerative disc disease (DDD) and had failed nonoperative treatment, according to a press release from DePuy announcing the study findings.

Follow-up averaged 13.2 years and ranged from 10 to 16.8 years. The data analysis included 106 of the 108 patients available for 10-year follow-up.

At latest follow-up, David found that 87 (82.1%) patients had either an excellent or good clinical outcome, measured using a modified Stauffer-Coventry scale. In addition, 90.6% retained prosthesis mobility, with range of motion averaging 10.1° in flexion-extension and 4.4° in lateral bending, according to the study.

Overall, 86 of 96 patients (89.6%) who worked preoperatively returned to work after undergoing surgery. Additionally, 28 of 36 patients (77.8%) who were employed at a hard labor level preoperatively returned to their same level of work, David noted.

"The patients in this series continue to do well after many years," David said in the press release.

"The results are encouraging since [it has] been more than 10 years since these patients had an implant and, since then, the instrumentation and techniques to implant the disc continue to evolve, as has the criteria for patient selection," he said in the release.

Postoperative complication rates were also lower than reported in the literature for patients treated with lumbar fusion, "... if transition syndrome (or adjacent level disease) is considered a complication of fusion," David said in the release. Specifically, there was a 2.8% rate of adjacent level disease requiring surgical intervention, roughly 10-times lower than some reports for lumbar fusion patients, the release said.

The overall reoperation rate was 10.4%, which included eight (7.5%) index-level posterior instrumented fusions. Also, five patients (4.6%) experienced postoperative facet arthrosis, three patients (2.8%) experienced subsidence, three patients (2.8%) had adjacent-level disease and two patients (1.9%) experienced core subluxation, according to the study.

For more information:
David T. Long-term results of one-level lumbar arthroplasty: Minimum 10-year follow-up of the Charité artificial disc in 106 patients. Spine. 2007;32:661-666.