Trial lecture – time and place
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Adjudication committee
- First opponent: Associate Professor Hans Tropp, Linköping University
- Second opponent: Professor Helena Brisby, Sahlgrenska Academy
- Chair to the Committee: Professor Nada Hadzic-Andelic, University of Oslo
Principal supervisor
- Professor Kjersti Storheim, Oslo University Hospital
Chair of the Public Defence
Professor Jan Erik Madsen, Institute of Clinical Medicine, University of Oslo
Summary
Low back pain is common and causes more disability than any other condition. Lumbar total disc replacement is a treatment option for selected patients with chronic low back pain and intervertebral disc degeneration. Total disc replacement was introduced as a motion-preserving alternative to spinal fusion, which has been reported to increase the risk of adjacent disc degeneration. However, adjacent disc degeneration may develop regardless of surgery, and previous studies have called the clinical importance of adjacent disc degeneration into question.
In this thesis, we aimed to assess the long-term outcomes following lumbar total disc replacement compared to multidisciplinary rehabilitation, to identify patient characteristics associated with a favourable long-term result and to assess the long-term development of adjacent disc degeneration following disc replacement compared to non-operative treatment.
The thesis is based on an eight-year follow-up of a multicentre randomised controlled trial performed at five university hospitals in Norway. The sample consists of 173 patients aged 25-55 years with chronic low back pain and localized degenerative changes in the lumbar intervertebral discs.
We found a substantial long-term improvement both after total disc replacement and multidisciplinary rehabilitation. The difference between the groups was statistically significant in favour of surgery, but smaller than the pre-specified clinical important difference that the study was designed to detect. Patients with Modic changes prior to the disc replacement were more likely to report a clinically important functional improvement. Patients with comorbidity, low level of education, long-term sick leave and low physical function score before treatment were more likely to be unemployed at long-term follow-up. Increased adjacent disc degeneration occurred with similar frequency after disc replacement and non-operative treatment and was not related to the long-term clinical outcome.
Additional information
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