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PVSS22. A Comparison of Two Retroperitoneal Surgical Approaches for Disc Arthroplasty of the Lumbar Spine

Martin Quirno, Thomas Errico, Norman Bloom, Jeffrey Spivak, Jeffrey Goldstein, John Bendo,  Matthew M. Nalbandian.
New York University, New York, N.Y.

OBJECTIVES: Anterior spine surgery is becoming a more common procedure in the practice of spine surgeons. Vascular surgeons may be asked to perform spine access surgery for their spine colleagues. There are two common anterior techniques that vascular surgeons may utilize for anterior spine access. We believe there is a significant difference between the midline rectus (MR) and the paramedian lateral rectus (PLR) approaches with regard to implant position for Synthes Prodisc-L arthroplasty. A less than optimal implant position may influence clinical outcome.

METHODS: Patients for this study were obtained from one of 17 centers participating in the prospective randomized FDA study for the evaluation of the ProDisc-LTM. We compared results obtained from two different surgical access techniques; Midline Rectus (MR) approach and left Paramedian Lateral Rectus (PLR) approach. Post-operative x-rays were measured from 57 patients of which 46% (26) of these patients were L4/L5 and 54% (31) were L5/S1. Post-operative x-rays were measured by two independent evaluators in order to calculate the displacement from the midline in the coronal and sagittal planes for each of the surgical techniques. Pre and Post-operative clinical outcomes were calculated to quantify which of these surgical access techniques was associated with better outcomes and if there was a clinical correlation with technical accuracy.

RESULTS: The PLR approach is associated with a significant malalignement only in the sagittal plane (p=0.021). There is no significant difference in clinical outcome for either approach (p=0.34). Patients with 5 mm prosthetic displacement from the mid-vertebral point have significantly worse ODI scores than patients with <3mm in both coronal and sagittal planes regardless of the surgical approach employed.

CONCLUSIONS: Vascular surgeons need to be comfortable with spine access approaches in order to provide safe exposure to the spine. This investigation demonstrates that significant clinical and radiographical differences do exist between use of the PLR and MR approaches and that these may indicate a need to change to the MR approach. This study also demonstrates that patients with  5 mm prosthetic deviation from midline in either the coronal or sagittal planes had poorer outcomes, regardless of the approach used.