Clinical Effectiveness and Return to Work Rate After Lumbar Total Disk Replacement and Microsurgical Lumbar Discectomy in Railway Workers: a Prospective Randomized Controlled Trial

Abstract

Abstract Objective. To compare the clinical efficacy and return to work rate after TDR (total disk replacement) and microsurgical lumbar discectomy (MLD) in railway workers with lumbar disk herniation (LDH). Methods. Seventy five patients, ages 25–35 years, underwent single-level procedure and were randomly assigned to one of two groups: group I (n = 37) had TDR and group II (n = 38) had MLD. The functional state was assessed using the ODI, pain severity was analyzed using the 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 were used to assess the efficacy of the respective surgical methods pre-operatively and last follow-up of 1-year. The percentage of patients who returned to work at 1 year and the time to return to work post-operatively were analyzed based on workload intensity. 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 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 return to work rate compared with MLD. 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 return to work rate compared to MLD.