Biomedical subjects

Patrick Tropiano

Publications and source records attributed to Patrick Tropiano.

8 recordsLinked to original sources

PubMed2006

Lumbar total disc replacement. Surgical technique.

BACKGROUND: Symptomatic lumbar degenerative disc disease is a challenging entity to treat. The results of arthrodesis may be compromised in the short term by pseudarthrosis and in the long term by pain at the iliac-crest donor site and by junctional degeneration. Total disc replacement has the potential to provide long-lasting relief to these patients. The purpose of this study was to present the clinical and radiographic results assessed seven to eleven years following a Prodisc total lumbar disc replacement. METHODS: Sixty-four patients had single or multiple-level implantation of a total lumbar disc replacement between 1990 and 1993. The mean duration of follow-up was 8.7 years. Clinical results were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and post-operative radiographs were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and post-operative radiographs were evaluated as well. Subgroup analysis was performed to determine if gender, an age of less than forty-five years, previous surgery, or multilevel surgery had an effect on outcome. RESULTS: At an average of 8.7 years post-operatively, there were significant improvements in the backpain, radiculopathy, disability, and modified Stauffer-Coventry scores. Thirty-three of the fifty-five patients with sufficient follow-up had an excellent result, eight had a good result, and fourteen had a poor result. Neither gender nor multilevel surgery affected outcome. An age of less than forty-five years and prior lumbar surgery had small but significant negative effects on outcome. Radiographs did not demonstrate loosening, migration, or mechanical failure in any patient. Five patients had approach-related complications. CONCLUSIONS: The Prodisc lumbar total disc replacement appears to be effective and safe for the treatment of symptomatic degenerative disc disease. Gender and multilevel surgery did not affect the outcomes, whereas prior lumbar surgery or an age of less than forty-five years was associated with slightly worse outcomes. Longer follow-up of this cohort of patients and randomized trials comparing disc replacement with arthrodesis are needed.

Adult↗

PubMed2005

Correlation between range of motion and outcome after lumbar total disc replacement: 8.6-year follow-up.

STUDY DESIGN: Retrospective radiographic and chart review. OBJECTIVE: To examine the relationship between lumbar total disc replacement (TDR) range of motion (ROM) and clinical outcome at 8.6-year follow-up. SUMMARY OF BACKGROUND DATA: There are no studies on the relationship between TDR motion and clinical outcomes. METHODS: We reviewed 38 patients who underwent 1 or 2-level TDR implantation with 51 TDR. Flexion-extension ROM was measured on lateral radiographs. Clinical outcomes were measured at 8.6 years by modified Stauffer-Coventry scores, Oswestry Disability Questionnaires (ODQ), and subjective ratings of back pain, leg pain, and disability. Spearman rank correlation coefficient was used to determine if ROM was correlated with clinical outcome. Patients were divided into 2 groups by motion (< or = 5 degrees and > 5 degrees ). Statistical differences in outcome were sought. RESULTS: Spearman rank correlation coefficient revealed weak-to-moderate but statistically significant associations between ROM and outcome for postoperative back pain (r = -0.35, P = 0.034), ODQ (r = -0.33, P = 0.046), and modified Stauffer-Coventry scores (r = 0.42, P = 0.0095). Patients with motion of > 5 degrees had superior outcomes in ODQ (mean difference 12.6 points, P = 0.026) and Stauffer-Coventry scores (mean difference 2.2 points, P = 0.015). CONCLUSIONS: The radiographic ROM at 8.6-year follow-up was positively correlated with several outcomes measures. Patients with motion > 5 degrees had clinically modest but statistically better outcomes in ODQ and modifiedStauffer-Coventry scores. Longer follow-ups will be necessary to measure fully the impact of TDR ROM on outcome.

Adult↗

PubMed2005

Hybrid constructs.

Hybrid constructs can combine motion-preserving technologies with each other or motion-preserving technologies with fusion techniques. Hybrid constructs can be implanted in single-stage or multistage surgeries. Early results are promising. Further study under formal scientific conditions is necessary to explore the benefit of these combinations.

Adult↗

PubMed2005

Lumbar total disc replacement. Seven to eleven-year follow-up.

BACKGROUND: Symptomatic lumbar degenerative disc disease is a challenging entity to treat. The results of arthrodesis may be compromised in the short term by pseudarthrosis and in the long term by pain at the iliac-crest donor site and by junctional degeneration. Total disc replacement has the potential to provide long-lasting relief to these patients. The purpose of this study was to present the clinical and radiographic results assessed seven to eleven years following a Prodisc total lumbar disc replacement. METHODS: Sixty-four patients had single or multiple-level implantation of a total lumbar disc replacement between 1990 and 1993. The mean duration of follow-up was 8.7 years. Clinical results were evaluated by assessing preoperative and postoperative lumbar pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Preoperative and postoperative radiographs were evaluated as well. Subgroup analysis was performed to determine if gender, an age of less than forty-five years, previous surgery, or multilevel surgery had an effect on outcome. RESULTS: At an average of 8.7 years postoperatively, there were significant improvements in the back-pain, radiculopathy, disability, and modified Stauffer-Coventry scores. Thirty-three of the fifty-five patients with sufficient follow-up had an excellent result, eight had a good result, and fourteen had a poor result. Neither gender nor multilevel surgery affected outcome. An age of less than forty-five years and prior lumbar surgery had small but significant negative effects on outcome. Radiographs did not demonstrate loosening, migration, or mechanical failure in any patient. Five patients had approach-related complications. CONCLUSIONS: The Prodisc lumbar total disc replacement appears to be effective and safe for the treatment of symptomatic degenerative disc disease. Gender and multilevel surgery did not affect the outcomes, whereas prior lumbar surgery or an age of less than forty-five years was associated with slightly worse outcomes. Longer follow-up of this cohort of patients and randomized trials comparing disc replacement with arthrodesis are needed.

Adult↗

PubMed2003

Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting.

STUDY DESIGN: Retrospective review. OBJECTIVES: To determine clinical and radiographic outcomes of thoracolumbar and lumbar burst fractures without neurologic injury treated by closed reduction and casting. Patient factors associated with poor outcome are identified. SUMMARY OF BACKGROUND DATA: The results of ambulatory bracing, surgery, and prolonged recumbency for burst fractures have been reported. There are no reports of results of closed reduction and casting. METHODS: Retrospective review of 41 neurologically intact patients with thoracolumbar and lumbar burst fractures was performed. Four patients with neurologic injury who refused surgery were included, for a total of 45 patients. All patients had closed reduction and casting. Functional, pain, and employment status were assessed using the Denis system. Neurologic function was graded using the Frankel scale. Radiographic evaluation of vertebral kyphosis, regional kyphosis, anterior body compression, and sagittal index were performed at time of injury, postreduction, 4 months, and final follow-up. RESULTS: Sixty-four percent of patients had minimal or no pain. Eight percent had constant, severe pain. At time of injury, 71% of patients were employed. At 8-month follow-up, 58% of patients were employed. Closed reduction resulted in significant correction of vertebral wedging from a mean of 15 degrees to 5 degrees. Deformity tended to recur by 4 months, but the degree of residual deformity appears to be less than that reported in other series. No complications resulted from the fracture reduction procedure. CONCLUSIONS: Closed reduction and casting of thoracolumbar and lumbar burst fractures is a safe treatment method that yields acceptable functional and radiographic results.

Absenteeism↗

PubMed2003

Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year.

Total disc replacement has the potential to replace fusion as the gold standard surgical treatment of degenerative disc disease. Potential advantages of disc replacement over fusion include avoidance of pseudarthrosis, postoperative orthoses, and junctional degeneration. After observing satisfactory clinical results at 7-11 years' follow-up with the ProDisc first-generation implant, a second-generation prosthesis was designed. This study is a prospective analysis of the early results of total disc replacement with the ProDisc II total disc prosthesis. Fifty-three patients had single-level or multilevel disc replacement and were evaluated clinically and radiographically preoperatively and at mean 1.4-year follow-up. There were clinically and statistically significant improvements in back and leg pain Visual Analog Scale and Oswestry disability scores that were maintained at final follow-up. The clinical results of patients with single- and multilevel surgery were equivalent. Satisfactory results were achieved in 90% of patients who had previous lumbar surgery. Complications occurred in 9% of patients and included vertebral body fracture, transient radicular pain, implant malposition, and transient retrograde ejaculation. Three patients (6%) required reoperation to address complications. No mechanical failure of the implants or loosening was observed, and the prostheses retained motion. Randomized, prospective, long-term studies will be necessary to compare the effectiveness of arthrodesis with total disc replacement.

Activities of Daily Living↗

PubMed2003

Long-term flexion-extension range of motion of the prodisc total disc replacement.

The rationale for total disc replacement is avoidance of the junctional degeneration seen after arthrodesis by preservation of segmental motion. To justify the use of disc prostheses, it is essential to document maintained range of motion (ROM) and sagittal alignment at long-term follow-up. This is a retrospective radiographic study of 42 patients who had placement of 58 first-generation Prodisc prostheses at a mean follow-up of 8.7 years. Flexion-extension ROM was measured by Cobb's method. Junctional levels were evaluated for junctional degeneration. Pre- and postoperative global and segmental lordosis were measured. Prognostic patient factors predicting ROM of <2 degrees were evaluated. We observed ROM of at least 2 degrees in 66% of Prodisc prostheses at 8.7-year follow-up, although ROM was less than that reported in asymptomatic normal individuals. Mean ROM for disc prostheses with motion was 7.5 degrees at L3-L4, 6.2 degrees at L4-L5, and 4.1 degrees at L5-S1. Mean ROM for all prostheses was 3.8 degrees. The incidence of radiographic junctional degeneration was 24%, although no patients required surgery for symptomatic junctional degeneration. Mean ROM of prostheses below a degenerated junctional disc was 1.6 degrees compared with 4.7 degrees below a normal junctional disc (P < 0.035). Females were 3.5 times more likely to have ROM of <2 degrees. This is the longest published follow-up study of a lumbar disc replacement. The data show that ROM is preserved at long-term follow-up in the majority of patients. Global and segmental sagittal alignment improve after surgery. Furthermore, there is an association between ROM of disc prostheses and the development of junctional degeneration.

Adult↗

PubMedDate not supplied

Range of motion and adjacent level degeneration after lumbar total disc replacement.

BACKGROUND CONTEXT: There are no published studies on the relationship between total disc replacement (TDR) motion and the development of adjacent level degeneration (ALD). Because prevention of ALD is the underlying justification for TDR, studies investigating the validity of this concept are essential. PURPOSE: To examine the relationship between range of motion (ROM) and ALD 8.7 years after lumbar TDR. STUDY DESIGN/SETTING: Retrospective radiographic and chart review. PATIENT SAMPLE: Forty-two patients 8.7 years after lumbar TDR. OUTCOME MEASURES: Radiographic flexion-extension and ALD. Modified Stauffer-Coventry score. Oswestry Disability Questionnaire. Subjective patient ratings of back pain, leg pain, and disability. METHODS: We reviewed the flexion-extension radiographs of 42 patients 8.7 years after TDR. Cephalad adjacent levels were evaluated for degeneration: loss of disc space height, anterior osteophyte formation, or dynamic flexion-extension instability. Graphical analysis of motion and the prevalence of ALD was performed. A statistical relationship between ALD and clinical outcome was sought. RESULTS: Ten of 42 patients evaluated (24%) had radiographic ALD. The mean motion was 3.8 degrees +/-2.0 degrees. The patients with ALD had mean motion of 1.6 degrees +/-1.3 degrees whereas the patients without ALD had motion of 4.7 degrees +/-4.5 degrees (p=.035). A clear relationship between motion and the presence of ALD at 8.7-year follow-up was observed. Patients with motion 5 degrees or greater (n=13) had a 0% prevalence of ALD. Patients with motion less than 5 degrees (n=29) had a 34% prevalence of ALD (p=.021, odds ratio 13.5). ALD had no statistically significant effect on clinical outcome although the sample size was small. CONCLUSIONS: At 8.7-year follow-up, the prevalence of ALD after TDR is higher in patients with motion less than 5 degrees. The presence of ALD had no significant effect on clinical outcome, but the sample size was small. These data suggest that patients with significant ROM after lumbar TDR may have reduced risk for radiographic ALD.

Adult↗