• Matthew F Gornet, Francine Schranck, Nicholas D Wharton, Douglas P Beall, Elizabeth Jones, Mark E Myers, and John A Hipp.
• The Orthopedic Center of St. Louis, St. Louis, MO, USA, mfgspine@gmail.com.
• Eur Spine J. 2014 Oct 1;23(10):2127-35.

PurposeThis study aimed at determining the variables that may prove useful in predicting clinical outcomes following lumbar disc arthroplasty.MethodsPre- and post-operative imaging assessments were obtained for 99 single-level lumbar disc arthroplasty patients from a prospective IDE study. The assessments and patient demographics were tested to identify variables that were significantly associated with clinical outcomes.ResultsClinical outcome data were available for 85 % of patients at the 5-year follow-up. Numerous assessments made from the pre-operative imaging were found to have statistically significant associations with clinical outcomes at 2 and 5 years. The most notable factors were related to the amount of degeneration at the index level, with patients achieving better outcome scores at 5 years if they have higher grades of degeneration preoperatively.ConclusionsSeveral variables may prove effective at optimizing clinical outcomes including a preoperative disc height <8 mm, Modic type 2 changes adjacent to the target disc, a low amount of lordosis present at the treatment level, low levels of fatty replacement of the paraspinal musculature, a prominent amount of facet joint or disc degeneration, and the presence of flat or convex vertebral endplates. There were also post-operative findings associated with better patient outcomes including a larger percent of the endplate covered with the implant, larger implant heights, greater increases in disc space heights, and a larger increase in index level lumbar lordosis. These variables could be explored in other clinical studies to facilitate meta-analyses that could identify effective strategies to optimize clinical outcomes with lumbar disc arthroplasty.

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