요추 인공 추간판 치환술의 현재 상황 (current status of lumbar total disc replacement(TDR))

서지정보

· 발행기관 : 대한척추외과학회
· 수록지 정보 : 대한척추외과학회지 / 15권 / 2호 / 115 ~ 131페이지
· 저자명 : 이종서

초록

Fusion surgery remains the gold standard for surgical treatment of lumbar degenerative disc disease (DDD). However, fusionsurgery has many intrinsic problems related to altered biomechanics and balance. Total disc replacement (TDR) has receivedincreasing attention over the last several years because of its capacity for both functional and symptomatic improvement and itsavoidance of problems intrinsic to fusion surgery. Artificial disc replacement is not a new concept, the first attempts havingbeen undertaken in the early 1950s. However, during the past 15 years, considerable advances have been made, with clinicalsuccess noted in several prospective randomized studies and mid-long term retrospective studies. Proper patient selection andsurgical technique are key factors in achieving a successful outcome. TDR plays a limited role and has limited indications forreplacing fusion surgery in patients with lumbar DDD. The main goal of TDR is restoration of normal intervertebral disc func-tion. Varying degrees of motion can be restored through TDR; however, the pattern of motion and center of rotation are notphysiologic. In spite of some favorable reports, many TDR-related problems remain to be solved. Successful disc function ismeasured not only in terms of quantity of motion, but also in terms of quality of motion and shock energy absorption capacity.For successful repair to be declared, facet unloading should be achieved, and fatigue strength should be improved. New proce-dures should be characterized by a reduction in the technical problems of implantation and retrieval. We expect that the nextgeneration of TDR will overcome the limitations of first generation TDR. This therapeutic modality shows much promise forthe treatment of lumbar DDD.

영어초록

Fusion surgery remains the gold standard for surgical treatment of lumbar degenerative disc disease (DDD). However, fusionsurgery has many intrinsic problems related to altered biomechanics and balance. Total disc replacement (TDR) has receivedincreasing attention over the last several years because of its capacity for both functional and symptomatic improvement and itsavoidance of problems intrinsic to fusion surgery. Artificial disc replacement is not a new concept, the first attempts havingbeen undertaken in the early 1950s. However, during the past 15 years, considerable advances have been made, with clinicalsuccess noted in several prospective randomized studies and mid-long term retrospective studies. Proper patient selection andsurgical technique are key factors in achieving a successful outcome. TDR plays a limited role and has limited indications forreplacing fusion surgery in patients with lumbar DDD. The main goal of TDR is restoration of normal intervertebral disc func-tion. Varying degrees of motion can be restored through TDR; however, the pattern of motion and center of rotation are notphysiologic. In spite of some favorable reports, many TDR-related problems remain to be solved. Successful disc function ismeasured not only in terms of quantity of motion, but also in terms of quality of motion and shock energy absorption capacity.For successful repair to be declared, facet unloading should be achieved, and fatigue strength should be improved. New proce-dures should be characterized by a reduction in the technical problems of implantation and retrieval. We expect that the nextgeneration of TDR will overcome the limitations of first generation TDR. This therapeutic modality shows much promise forthe treatment of lumbar DDD.

참고자료

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