Surgical techniques of prosthetic disc-nucleus (PDN) replacement and early results of the PDN-SOLO device
Chan Shik Shim, Sang-Ho Lee
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Intervertebral disk displacement/surgery; prostheses and implants; prosthesis design; spinal fusion/instrumentation/methods.
Objectives: Prosthetic disc-nucleus (PDN) replacement has the advantage that it can be performed with a minimally invasive technique, preserving the anterior longitudinal ligament, annulus fibrosus, and cartilaginous end plates. This study reviewed techniques and indications of surgical approaches and reported early clinical results of nucleus replacement with the PDN-SOLO device.
Patients and methods: From October 2002 to July 2004, a total of 167 patients were treated with the PDN-SOLO device, and clinical data of 70 patients whose follow-up period was more than three months were analyzed. Insertion of the device was performed with one of the following approaches: posterior, anterolateral transpsoatic, paraspinal transforaminal, and bilateral posterior approach.
Results: The mean preoperative Oswestry Disability Index score was 56%. It improved to 18.3% postoperatively. The mean visual analog scale scores for back pain were 7.5 and 2.5 before and after surgery, respectively. The results were successful in 60 patients (90%). Clinical failure was encountered in seven patients (10%), which included device extrusion (n=5), infection (n=1), and persistent back pain (n=1).
Conclusion: Early clinical results of the PDN-SOLO were found successful in patients with degenerative disc disease presenting with chronic back pain. The main complication of extrusion can be avoided through a successful implantation which warrants a high-level training on the detailed surgical technique and tactics of preparation of adequate space for the PDN-SOLO device.