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. 2006 Feb;15(2):183-95.
doi: 10.1007/s00586-005-1022-3. Epub 2005 Oct 28.

Charité total disc replacement--clinical and radiographical results after an average follow-up of 17 years

Michael Putzier  1 , Julia F Funk, Sascha V Schneider, Christian Gross, Stephan W Tohtz, Cyrus Khodadadyan-Klostermann, Carsten Perka, Frank Kandziora
Affiliations

Charité total disc replacement--clinical and radiographical results after an average follow-up of 17 years

Michael Putzier et al. Eur Spine J. 2006 Feb.

Abstract

A retrospective clinical-radiological study to evaluate the long-term outcome after artificial disc replacement was performed. The objective is to investigate long-term results after implantation of a modular type artificial disc prosthesis in patients with degenerative disc disease (DDD). Total disc replacement (TDR) is a surgical procedure intended to save segmental spinal function, and thus replace spondylodesis. Short-term results are promising, whereas long-term results are scarce. The Charité TDR is the oldest existing implant, therefore, the longest possible follow-up is presented here. Seventy-one patients were treated with 84 Charité TDRs types I-III. Indication for TDR was moderate to severe DDD. Fifty-three patients (63 TDRs) were available for long-term follow-up of 17 years. Evaluation included Oswestry disability index, visual analog scale, overall outcome score, plain and extension/flexion radiographs. Implantation of Charité TDR resulted in a 60% rate of spontaneous ankylosis after 17 years. No significant difference between the three types of prostheses was found concerning clinical outcome. Reoperation was necessary in 11% of patients. Although no adjacent segment degeneration was observed in the functional implants (17%), these patients were significantly less satisfied than those with spontaneous ankylosis. TDR, nowadays, is an approved procedure. Proof that long-term results of TDR implantation in DDD are at least as good as fusion results is still missing.

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Figures

Fig. 1
Fig. 1
X-rays of a 65-year-old female with typical implant failure with following fusion in a Charité type II TDR. a–d Nineteen years after TDR
Fig. 2
Fig. 2
X-rays of a 64-year-old female, 11 years after TDR treated with secondary instrumented spondylodesis: (a) preoperative, (b) 5 years postoperative, (c) 10 years postoperative, (d, e) at follow-up
Fig. 3
Fig. 3
X-rays of a 64-year-old female without radiologically verifiable changes at the operated levels at follow-up: (a) preoperative, (b) postoperative, (c, d) 15 years after TDR
Fig. 4
Fig. 4
X-rays of a 63-year-old male with spontaneous ankylosis after TDR with the type III Charité prosthesis: (a) preoperative, (b, c) postoperative, (d–f) 14 years after TDR; (d) extension, (e) flexion and (f) a.p.
Fig. 5
Fig. 5
X-rays of a 68-year-old male with spontaneous ankylosis after TDR with the type II Charité prosthesis: (a) flexion, (b) extension; 17 years after TDR
Fig. 6
Fig. 6
X-rays of a 68-year-old female with adjacent segment degeneration after TDRL: (a, b) preoperative, (c, d) postoperative, (e, f) 17 years after TDR
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Comment in

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