Proposed overview how to determine types of TDR in relation to patient selection criteria.
| Preoperative factor | Functional three component spherical ball and socket disc | Functional two component spherical ball and socket disc | One-piece viscoelastic disc with movable core | Compact (stiff) one-piece viscoelastic disc | |
|---|---|---|---|---|---|
| Patient Selection Criteria | |||||
| Patient data and medical history | Age | 20-40 | 20-40 | 30-50 | 40- >60 (precondition >50 y: sclerosis of endplates) |
| Back pain | yes | yes | yes | yes | |
| Leg pain | yes | yes | yes | yes, no > 50 y | |
| Duration of non-surgical treatment | 20-30 y: 9 months 30-40 y: 6 months | 20-30 y: 9 months 30-40 y: 6 months | 30-40 y: 6 months 40-50 y: 5 months | 40-50 yrs: 5 months 50-60 yrs: 4 months >60: 3 months | |
| Prior surgery | no (besides nucleotomy/discectomy without destabilizing bone resection) | no (besides nucleotomy/discecomy without destabilizing bone resection) | no (besides nucleotomy/discectomy without destabilizing bone resection) | yes (without facet-resection or laminectomy) | |
| Pain and disability | VAS | > 50/100 | > 50/100 | > 40/100 | > 40/100 |
| ODI | >macr; 40/100 | >macr; 40/100 | >macr; 40/100 | >macr; 40/100 | |
| Clinical findings | No severe nerve stretching findings | no severe nerve stretching findings | no severe nerve stretching findings | no severe nerve stretching findings | No severe nerve stretching findings |
| Radiographic findings | Maximal reduced disc height compared to upper healthy disc | 1/2 | 1/2 | 1/2 | 2/3 |
| Osteochondrosis | yes | yes | yes | yes | |
| Degenerative spondylolisthesis | no | no | no | Yes< 3mm | |
| Isthmic spondylolisthesis | no | no | no | no | |
| Degenerative scoliosis | no | no | minimal | yes | |
| Bony stenosis of spinal canal | no | no | no | no | |
| Facet arthritis grades85 | up to grade II | up to grade II | up to grade II | up to grade III | |
| Facetectomy | no | no | no | no | |
| MRI | Nucleus pulposus prolapse at disc level with nerve root irritation (= anterior discectomy possible) | yes | yes | yes | yes |
| Modic changes | yes | yes | yes | yes | |
| Invasive diagnostic procedures | Facet joint injection | no reduced pain | no reduced pain | no reduced pain | < 50% reduced pain |
| Specific pain at discography | yes | yes | yes | yes | |
| Reduced leg pain at periradicular injection | +/- | +/- | +/- | +/- | |
| Bone quality | DEXA | T > -1.0 | T > -1.0 | T > -1.0 | T > -1.0 |
| Psychosocial / psychological factors | Result of test(s) | negative | negative | negative | negative |
| Surgical experience | Possible number of levels | 1 | 1-2 | 1-2 | > 2 |