Comparison between total disc replacement and hybrid construct at two lumbar levels with minimum follow-up of two years

Introduction: Lower back pain due to degenerative disc disease is a therapeutic challenge in young patients. Although arthrodesis is currently the gold standard for surgical treatment, improvement in total disc replacement techniques makes it possible to preserve segmental mobility with good results in one-level surgery. Nevertheless, the French National Health Authority does not recommend total disc replacement for multilevel surgery. Thus, hybrid constructs that combine one-level disc replacement with arthrodesis have been developed for multilevel indications. Hypothesis: The outcome of two-level lumbar disc arthroplasty does not differ from hybrid constructs. Methods: The clinical and radiographic outcomes of disc arthroplasty were compared to hybrid constructs for two-level degenerative disc disease in 72 patients after a continuous follow-up of at least 2 years. The patients were divided into two groups that were similar for the indication and type of implants. Results: There was no statistical difference in pain relief (-3.9 points versus 3.5 points for lumbar VAS) or reduction in ODI (-29.5% versus 27.0%) between TDR and hybrid constructs, respectively. There was no statistical difference in range of motion at the level of arthroplasty (8.4 versus 7.6) and no kinematic dysfunction was identified. The re-operation rate at two years for persistent lumbar pain was respectively 6.7% for two-level disc arthroplasty and 4.3% for hybrid constructs. The complication rate was 4.8% and 8.7% respectively. Discussion: No difference was found in this comparison of two homogeneous series between two-level disc arthroplasty and hybrid constructs for the treatment of degenerative disc disease after two years of follow-up. Two-level disc arthroplasty may be an alternative for young patients depending on an evaluation of long-term results. Level of evidence: Cohort observational study level III. (C) 2016 Elsevier Masson SAS. All rights reserved.