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Journal of Long-Term Effects of Medical Implants

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v18.i4.40
pages 303-307

Lumbar Total Disc Arthroplasty: Coronal Midline Definition and Optimal TDA Placement

Laurence A.G. Marshman
University Hospital of North Tees, Department of Spinal Surgery, Hardwick, Stockton North Tees
Tai Friesem
University Hospital of North Tees, Department of Spinal Surgery, Hardwick, Stockton North Tees
Y. Raja Rampersaud
Toronto Western Hospital, Department of Spine Surgery, Toronto, Ontario
Jean-Charles Le Huec
Department Orthopédie Pr Chauveaux, Spine Unit Pr Le Huec, CHU Pellegrin Tripode, Bordeaux
Manoj Krishna
University Hospital of North Tees, Department of Spinal Surgery, Hardwick, Stockton North Tees
Guru R. Reddy
University Hospital of North Tees, Department of Spinal Surgery, Hardwick, Stockton North Tees

ABSTRACT

It is a general principle with arthroplasty insertion that precise implant centring is critical for long term function and outcome. Whilst some authors have proclaimed that lumbar total disc arthroplasty (TDA) may be different, and that off -centre placement may be functionally well tolerated, these claims are premature: significantly worse clinical results have already been reported with poorly placed TDA at 2years. Accurate TDA placement requires a precise and consistent definition of the desired coronal midline target (which is currently lacking), as well as a procedural mechanism to optimize placement at that target. We summarize our experience, as well as others', in achieving these two requirements. Long-term outcomes after lumbar TDA insertion should only be compared with results from fusion where TDAs have been implanted accurately.