Transpedicular Lumbar Fusion in Patients without Improvement of Low Back Pain Following Implantation of Disc Prostheses.

AIM: To evaluate the option of lumbar transpedicular fixation at the index level in patients who did not achieve adequate pain relief after lumbar total disc replacement (TDR) without evidence of device failure. MATERIAL AND METHODS: Four patients (mean age, 47 years) presented with persistent low back pain following lumbar TDR for 12-24 months (mean, 16.3). No device failures were observed. All patients underwent transpedicular fixation at the index level. Clinical outcome was assessed via the Oswestry disability index, a visual analog scale, and recording of the consumption of analgesics. RESULTS: No postoperative complications were observed. The average follow-up after lumbar transpedicular fixation was 53.5 months (range, 43-80). Two patients considered the outcome as excellent, one as good, and one as poor. The mean visual analog scale pain score decreased from 7.8 (range, 7-8) to 4.3 (range, 2-8). The mean Oswestry disability index decreased from 43.5 (range, 39?47) to 27.5 (range, 14-47). At the last follow-up, one patient was without analgesic medication and substitution of opiates with non-opioid analgesics was possible in two patients. CONCLUSION: In patients with persistent low back pain after TDR without device failure or adjacent segment pathologies, lumbar transpedicular fixation without removal of the disc prosthesis may be a useful therapeutic option.