Correlation between preoperative characteristics of lumbar segments and late postoperative clinical outcomes of lumbar total disc arthroplasty and transforaminal lumbar interbody fusion in railway workers

Introduction Long-term clinical outcomes can be optimized based on degeneration mechanisms of microstructural changes in the supporting elements of the spine and an objective assessment of the severity of pathological changes and the extent of surgical intervention.

The objective was to explore the relationship between preoperative age, behavioral, physiological, professional characteristics of patients, morphological and radiological parameters of the lumbar segments and long-term surgical outcomes of railway workers with degenerative diseases of the spine treated with lumbar total disc arthroplasty (LTDA) and transforaminal lumbar interbody fusion (TLIF) to objectify indications for the use.

Material and methods Surgical outcomes of 223 railway workers with single-segment lumbar degenerative disease treated with LTDA (n = 64) and TLIF (n = 159) between 2015 and 2018 were retrospectively reviewed. Univariate logistic regression analysis was used to identify and evaluate the influence of various risk factors on poor clinical outcomes.

Results A long-term poor outcome of lumbar LTDA was associated with age > 40 years, body mass index > 28 kg/m², smoking, posterior osteophytes, dynamic sagittal angle over 10°, decreased interbody height of > ½ of the overlying one, Pfirrmann disc degeneration greater than stage III, A. Fujiwara facet joint osteoarthritis greater than stage II, the apparent diffusion coefficient (ADC) less than 1200 mm²/sec, facet angle > 60°, tropism of the facet joint, cellular density of the nucleus pulposus < 1500 cells/mm³, collagen types X and XI. For TLIF, the factors included body mass index over 28 kg/m², smoking, category III energy expenditure at work, dynamic linear translation < 4 mm, facet angle < 60°.

Discussion The findings suggested systematization of patients considering the severity of preoperative degenerative changes in the lumbar segments providing an optimal choice of surgical strategy and prediction of the postoperative follow-up.

Conclusion A unified choice of surgical technology, a comprehensive analysis of preoperative age, behavioral (smoking), physiological (BMI), professional (level of energy expenditure) parameters, morphological and radiological characterization of the lumbar segments were essential for effective treatment of clinical symptoms in the late postoperative period in railway workers with single-level degenerative disease of the lumbar segments.

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