• Håvard Furunes, Christian Hellum, Jens Ivar Brox, Ivar Rossvoll, Ansgar Espeland, Linda Berg, Helga Maria Brøgger, Milada Cvancarova Småstuen, and Kjersti Storheim.
• Department of Surgery, Innlandet Hospital Gjøvik, Kyrre Grepps Gate 11, 2819, Gjøvik, Norway. havardfurunes@gmail.com.
• Eur Spine J. 2018 Mar 1; 27 (3): 709-718.

PurposeWe aimed to identify patient characteristics associated with favourable long-term outcomes after lumbar total disc replacement (TDR).MethodsWe analysed a cohort of 82 patients with degenerative disc and chronic low back pain (LBP) who were treated with TDR and originally participated in a randomised trial comparing TDR and multidisciplinary rehabilitation. Potential predictors were measured at baseline, and the outcomes assessed 8 years after they received allocated treatment. Outcome measures were dichotomised according to whether the participants achieved a clinically important functional improvement (15 points or more on the Oswestry Disability Index, ODI) (primary outcome) and whether they were employed at 8-year follow-up (secondary outcome). Associations between potential predictors and outcomes were modelled using logistic regression. For the secondary outcome, the results were also organised in a prediction matrix and expressed as probabilities.ResultsFor 71 patients treated with TDR according to protocol, the follow-up time was 8 years. For a subgroup of 11 patients randomised to rehabilitation who crossed over and received TDR, the median postoperative follow-up time was 72 (range 41-88) months. Of all assessed baseline variables, only presence of Modic changes (type 1 and/or 2) was statistically significantly associated with an improvement of ≥ 15 ODI points. The probability of employment at 8-year follow-up was 1% for patients with ≥ 1 year of sick leave, comorbidity, ODI ≥ 50 and ≤ 9 years of education prior to treatment, and 87% for patients with < 1 year of sick leave, no comorbidity, ODI < 50 and higher education.ConclusionsPatients with Modic changes prior to the TDR surgery were more likely to report a clinically important functional improvement at long-term follow-up. Comorbidity, low level of education, long-term sick leave and high ODI score at baseline were associated with unemployment at long-term follow-up.

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