Lumbar total disk replacement versus microsurgical lumbar discectomy in treatment of radicular and back pain in railway workers: a prospective randomized controlled trial.

Background: Currently, there remains a high percentage of complications after lumbar discectomy, while there is no uniform tactic to prevent their development. Purpose of the study was to compare the clinical efficacy and return to work rate (RWR) after total disk replacement (TDR) and microsurgical lumbar discectomy (MLD) in railway workers with lumbar disk herniation (LDH). Methods: We randomly assigned 75 patients out of a total of 81 patients, between 25 and 35 years of age who had one level LDH to undergo single-level TDR surgery (group I, n=37) or MLD surgery (group II, n=38) in the L4-L5 or L5-S1 segments. The functional state was assessed using the Oswestry Disability Index (ODI), pain severity was analyzed using the Visual Analogue Scale (VAS) for back pain and leg pain, quality of life was assessed according to SF-36 preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. The X-ray assessment was used to assess the efficacy of the respective surgical methods pre-operatively and last follow-up of 1-year. Workload intensity criterions were used to analyze return to work 1 year after surgery. Clinical and radiographic observers were blinded for the assigned treatment during the 12-month follow-up. Results: As expected, the MLD group had statistically significantly lower duration of surgery and less bleeding than TDR group. At a 1-year follow-up period, the TDR group had significantly better ODI, VAS and SF-36 than the MLD group. The postoperative X-ray revealed a statistically significant difference of the range of motion (ROM) and global lumbar lordosis in TDR group compared to the MLD group. After TDR procedure in light-moderate and heavy-very heavy workload patients groups had a statistically significantly higher RWR compared with MLD. The analysis revealed a comparable number of symptomatic complications in both groups (P=0.47), with a greater frequency of reoperations in the follow-up period in MLD group in comparison TDR group (P=0.04). Conclusions: The use of single-level TDR in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of reoperations, restore of segmental mobility at operation level, preserve of global lumbar lordosis and RWR compared to MLD. Trial Registration: Russian Clinical Trial Registry 622011400059-4.