• Rolando Garcia, James J Yue, Scott Blumenthal, Dom Coric, Vikas V Patel, Scott P Leary, DinhDzung HDH, Glenn R Buttermann, Harel Deutsch, Federico Girardi, James Billys, and Larry E Miller.
• *Orthopedic Care Center†Yale School of Medicine‡Texas Back Institute§Carolina Neurosurgery and Spine Associates¶Anschutz Medical Campus, University of Colorado||SENTA Clinic and Scripps Health**Illinois Neurological Institute††Midwest Spine Institute‡‡Rush University Medical Center§§Hospital for Special Surgery¶¶Florida Orthopaedic Institute||||Miller Scientific Consulting, Inc.
• Spine. 2015 Dec 1; 40 (24): 1873-81.

Study DesignA prospective, multicenter, randomized, controlled, investigational device exemption (IDE) noninferiority trial.ObjectiveThe aim of this study was to evaluate the comparative safety and effectiveness of lumbar total disc replacement (TDR) in the treatment of patients with symptomatic degenerative disc disease (DDD) who are unresponsive to nonsurgical therapy.Summary Of Background DataLumbar TDR has been used to alleviate discogenic pain and dysfunction while preserving segmental range of motion and restoring stability. There is a paucity of data available regarding the comparative performance of lumbar TDR.MethodsPatients presenting with symptomatic single-level lumbar DDD who failed at least 6 months of nonsurgical management were randomly allocated (2:1) to treatment with an investigational TDR device (activL, n = 218) or FDA-approved control TDR devices (ProDisc-L or Charité, n = 106). The hypothesis of this study was that a composite effectiveness outcome at 2 years in patients treated with activL would be noninferior (15% delta) to that in controls.ResultsThe primary composite endpoint of this study was met, which demonstrated that the activL TDR was noninferior to control TDR (P < 0.001). A protocol-defined analysis of the primary composite endpoint also confirmed that activL was superior to controls (P = 0.02). Radiographic success was higher with activL versus controls (59% vs. 43%; P < 0.01). Mean back pain severity improved by 74% with activL and 68% with controls. Oswestry Disability Index scores decreased by 67% and 61% with activL and controls, respectively. Patient satisfaction with treatment was over 90% in both groups at 2 years. Return to work was approximately 1 month shorter (P = 0.08) with activL versus controls. The rate of device-related serious adverse events was lower in patients treated with activL versus controls (12% vs. 19%; P = 0.13). Surgical reintervention rates at the index level were comparable (activL 2.3%, control 1.9%).ConclusionThe single-level activL TDR is safe and effective for the treatment of symptomatic lumbar DDD through 2 years.Level Of Evidence2.

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