Abstract
Despite the increasing popularity of total lumbar disc replacement (TDR) in predominantly young and active patients, no previous study has addressed possibilities, limitations and potential risks regarding athletic performance following TDR. Mechanical concerns remain and the implant’s resilience as regards its load-bearing capacity during sporting activities is unknown. Thirty-nine athletic patients fulfilled the inclusion criteria for this study. These patients participated in a large variety of different types of sport. Significant and lasting pain-relief was attained following TDR with a mean follow-up of 26.3 months (range 9–50.7 months; FU rate 97.4%). Sporting activity was resumed within the first 3 months (38.5%) to 6 months (30.7%) with peak performance being reached after 5.2 months. Thirty-seven patients (94.9%) achieved resumption of sporting activity. Athletic performance improved significantly in 33 patients (84.6%). Minor subsidence was observed in 13 patients (30%) within the first 3 months with no further implant migration thereafter in 12 patients. Participation in all types of sport recorded in this study was accessible for a high rate of patients up to the level of professional athletes as well as those participating in extreme sports. Preoperative participation in sport proved to be a strong positive predictor for highly satisfactory postoperative outcome following TDR. In a selected group of patients, however, preoperative inability to participate in sporting activities did not impair postoperative physical activity. Due to the young age of the patients and significant load increase exerted during athletic activities, persisting concerns regarding the future behaviour of the implant remain and will require longer follow-up, modified investigation techniques and larger patient cohorts.
Similar content being viewed by others
References
Anderson PA, Rouleau JP (2004) Intervertebral disc arthroplasty. Spine 29:2779–2786
Bahr R, Andersen SO, Loken S, Fossan B, Hansen T, Holme I (2004) Low back pain among endurance athletes with and without specific back loading—a cross-sectional survey of cross-country skiers, rowers, orienteerers, and nonathletic controls. Spine 29:449–454
Bertagnoli R, Marnay T, Mayer HM (eds) (2003) Spine Solutions GmbH. The ProDisc Book, Tuttlingen
Bertagnoli R, Yue JJ, Shah RV, Nanieva R, Pfeiffer F, Fenk-Mayer A, Kershaw T, Husted DS (2005) The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the ProDisc prosthesis: a prospective study with 2-year minimum follow-up. Spine 30:2192–2199
Block AR, Vanharanta H, Ohnmeiss DD, Guyer RD (1996) Discographic pain report. Influence of psychological factors Spine 21:334–338
Blumenthal S, McAfee PC, Guyer RD, Hochschuler SH, Geisler FH, Holt RT, Garcia R Jr, Regan JJ, Ohnmeiss DD (2005) A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine 30:1565–1575; discussion E1387–E1591
Bono CM (2004) Low-back pain in athletes. J Bone Joint Surg Am 86-A:382–396
Cakir B, Richter M, Puhl W, Schmidt R (2006) Reliability of motion measurements after total disc replacement: the spike and the fin method. Eur Spine J 15:165–173
Cappozzo A, Felici F, Figura F, Gazzani F (1985) Lumbar spine loading during half-squat exercises. Med Sci Sports Exerc 17:613–620
Carragee EJ, Tanner CM, Yang B, Brito JL, Truong T (1999) False-positive findings on lumbar discography. Reliability of subjective concordance assessment during provocative disc injection. Spine 24:2542–2547
Carragee EJ, Chen Y, Tanner CM, Hayward C, Rossi M, Hagle C (2000) Can discography cause long-term back symptoms in previously asymptomatic subjects? Spine 25:1803–1808
Cheng CK, Chen HH, Chen CS, Lee SJ (1998) Influences of walking speed change on the lumbosacral joint force distribution. Biomed Mater Eng 8:155–165
Cholewicki J, McGill SM, Norman RW (1991) Lumbar spine loads during the lifting of extremely heavy weights. Med Sci Sports Exerc 23:1179–1186
Chung SS, Lee CS, Kang CS, Kim SH (2006) The effect of lumbar total disc replacement on the spinopelvic alignment and range of motion of the lumbar spine. J Spinal Disord Tech 19:307–311
Cinotti G, David T, Postacchini F (1996) Results of disc prosthesis after a minimum follow-up period of 2 years. Spine 21:995–1000
Delamarter RB, Fribourg DM, Kanim LE, Bae H (2003) ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 28:S167–S175
Dvorak J, Panjabi MM, Chang DG, Theiler R, Grob D (1991) Functional radiographic diagnosis of the lumbar spine. Flexion-extension and lateral bending. Spine 16:562–571
Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Frobin W, Brinckmann P, Leivseth G, Biggemann M, Reikeras O (1996) Precision measurement of segmental motion from flexion-extension radiographs of the lumbar spine. Clin Biomech (Bristol, Avon) 11:457–465
Gatt CJ Jr, Hosea TM, Palumbo RC, Zawadsky JP (1997) Impact loading of the lumbar spine during football blocking. Am J Sports Med 25:317–321
Granhed H, Morelli B (1988) Low back pain among retired wrestlers and heavyweight lifters. Am J Sports Med 16:530–533
Guyer RD, Ohnmeiss DD (2003) Intervertebral disc prostheses. Spine 28:S15–S23
Hainline B (1995) Low back injury. Clin Sports Med 14:241–265
Hallab N, Link HD, McAfee PC (2003) Biomaterial optimization in total disc arthroplasty. Spine 28:S139–S152
Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B (2001) Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine 26:E235–E242
Hosea TM, Boland AL (1989) Rowing Injuries. Postgrad Adv Sports Med III:1–17
Hosea TM, Gatt CJ Jr, McCarthy KE, Langrana NA, Zawadsky JP (1989) Analytical computation of rapid dynamic loading of the lumbar spine. Trans Orthop Res Soc 14:358
Huang RC, Girardi FP, Cammisa FP Jr, Tropiano P, Marnay T (2003) Long-term flexion-extension range of motion of the prodisc total disc replacement. J Spinal Disord Tech 16:435–440
Huang RC, Lim MR, Girardi FP, Cammisa FP Jr (2004) The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients. Spine 29:2538–2541
Huang RC, Girardi FP, Cammisa FP Jr, Lim MR, Tropiano P, Marnay T (2005) Correlation between range of motion and outcome after lumbar total disc replacement: 8.6-year follow-up. Spine 30:1407–1411
Le Huec JC, Basso Y, Aunoble S, Friesem T, Bruno MB (2005) Influence of facet and posterior muscle degeneration on clinical results of lumbar total disc replacement: two-year follow-up. J Spinal Disord Tech 18:219–223
Junge A, Frohlich M, Ahrens S, Hasenbring M, Sandler A, Grob D, Dvorak J (1996) Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years’ follow up. Spine 21:1056–1064; discussion 1064–1055
de Kleuver M, Oner FC, Jacobs WC (2003) Total disc replacement for chronic low back pain: background and a systematic review of the literature. Eur Spine J 12:108–116
Kostuik JP (1997) Intervertebral disc replacement. Experimental study. Clin Orthop Relat Res (337):27–41
Ledet EH, Tymeson MP, DiRisio DJ, Cohen B, Uhl RL (2005) Direct real-time measurement of in vivo forces in the lumbar spine. Spine J 5:85–94
Leivseth G, Braaten S, Frobin W, Brinckmann P (2006) Mobility of lumbar segments instrumented with a ProDisc II prosthesis: a two-year follow-up study. Spine 31:1726–1733
Lemaire JP, Carrier H, Ali el HS, Skalli W, Lavaste F (2005) Clinical and radiological outcomes with the Charite artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech 18:353–359
Lim MR, Girardi FP, Zhang K, Huang RC, Peterson MG, Cammisa FP Jr (2005) Measurement of total disc replacement radiographic range of motion: a comparison of two techniques. J Spinal Disord Tech 18:252–256
Lim MR, Loder RT, Huang RC, Lyman S, Zhang K, Sama A, Papadopoulos EC, Warner K, Girardi FP, Cammisa FP Jr (2006) Measurement Error of Lumbar Total Disc Replacement Range of Motion. Spine 31:E291–E297
Lotters F, Hogg-Johnson S, Burdorf A (2005) Health status, its perceptions, and effect on return to work and recurrent sick leave. Spine 30:1086–1092
Mayer HM, Wiechert K (2002) Microsurgical anterior approaches to the lumbar spine for interbody fusion and total disc replacement. Neurosurgery 51:S159–165
Mayer HM, Wiechert K, Korge A, Qose I (2002) Minimally invasive total disc replacement: surgical technique and preliminary clinical results. Eur Spine J 2(11Suppl):S124–S130
McAfee PC, Fedder IL, Saiedy S, Shucosky EM, Cunningham BW (2003) SB Charite disc replacement: report of 60 prospective randomized cases in a US center. J Spinal Disord Tech 16:424–433
McCalden RW, Naudie DD, Yuan X, Bourne RB (2005) Radiographic methods for the assessment of polyethylene wear after total hip arthroplasty. J Bone Joint Surg Am 87:2323–2334
Mirza SK (2005) Point of view: commentary on the research reports that led to Food and Drug Administration approval of an artificial disc. Spine 30:1561–1564
Morris FL, Smith RM, Payne WR, Galloway MA, Wark JD (2000) Compressive and shear force generated in the lumbar spine of female rowers. Int J Sports Med 21:518–523
Noailly J, Lacroix D, Planell JA (2005) Finite element study of a novel intervertebral disc substitute. Spine 30:2257–2264
van Ooij A, Oner FC, Verbout AJ (2003) Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord Tech 16:369–383
Polly DW Jr (2003) Adapting innovative motion-preserving technology to spinal surgical practice: what should we expect to happen? Spine 28:S104–S109
Ranson CA, Kerslake RW, Burnett AF, Batt ME, Abdi S (2005) Magnetic resonance imaging of the lumbar spine in asymptomatic professional fast bowlers in cricket. J Bone Joint Surg Br 87:1111–1116
Siepe CJ, Mayer HM, Wiechert K, Korge A (2006) Clinical results of total lumbar disc replacement with ProDisc II: three-year results for different indications. Spine 31:1923–1932
Siepe CJ, Mayer HM, Heinz-Leisenheimer M, Korge A (2006) Total lumbar disc replacement: different results for different levels. Spine (accepted for publication)
Tropiano P, Huang RC, Girardi FP, Marnay T (2003) Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year. J Spinal Disord Tech 16:362–368
Tropiano P, Huang RC, Girardi FP, Cammisa FP Jr, Marnay T (2005) Lumbar total disc replacement. Seven to eleven-year follow-up. J Bone Joint Surg Am 87-A:490–496
Videman T, Sarna S, Battie MC, Koskinen S, Gill K, Paananen H, Gibbons L (1995) The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine 20:699–709
Wang JC, Shapiro MS, Hatch JD, Knight J, Dorey FJ, Delamarter RB (1999) The outcome of lumbar discectomy in elite athletes. Spine 24:570–573
Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE (1999) New in vivo measurements of pressures in the intervertebral disc in daily life. Spine 24:755–762
Zigler JE (2003) Clinical results with ProDisc: European experience and U.S. investigation device exemption study. Spine 28:S163–S166
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Siepe, C.J., Wiechert, K., Khattab, M.F. et al. Total lumbar disc replacement in athletes: clinical results, return to sport and athletic performance. Eur Spine J 16, 1001–1013 (2007). https://doi.org/10.1007/s00586-006-0257-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-006-0257-y