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

Clinical Effectiveness and Return to Work Rate After Lumbar Total Disk Replacement and Microsurgical Lumbar Discectomy in Railway Workers: a Prospective Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Effectiveness and Return to Work Rate After Lumbar Total Disk Replacement and Microsurgical Lumbar Discectomy in Railway Workers: a Prospective Randomized Controlled Trial Vadim A. Byvaltsev, Andrei A. Kalinin, Yurii Ya. Pestryakov, Ravshan M. Yuldashev, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3908015/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. lumbar disk herniation microsurgical lumbar discectomy lumbar total disk replacement return to work workload intensity Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Low back pain and sciatica are among the leading causes of disability in the world [ 1 ]. A common cause of lower back and leg pain, is lumbar disc herniation (LDH) [ 2 ]. In cases of ineffectiveness of conservative measures for resolve patient clinical symptoms, a microsurgical discectomy using is used to remove the herniated intervertebral disk (IVD) and decompress the symptomatic nerve [ 3 ]. It was found that after lumbar discectomy have risk for symptom recurrence, loss of disc height with postoperative radiculopathy and reoperation associated with recurrent herniation [ 4 , 5 ]. So, high rate of LDH patients at 1 year after spinal surgery expressed unhappiness with the level of pain [ 6 ]. Rigid spinal fusion is frequently considered as one of the preferred methods of surgical treatment for patients with lumbar degenerative diseases [ 7 ]. Fusion techniques reduce pain by restricting the abnormal motion, reducing instability, and restoring spinal alignment [ 8 ]. However, rigid fixation of a spinal segment is considered to be one of the risk factors that may lead to accelerated degeneration of the adjacent level associated with increase intradiscal pressure [ 9 ]. The lumbar total disk replacement (TDR) in surgical treatment of degenerative disk disease is a known alternative to fusion interventions in specific cases [ 10 ]. This technology preserve of natural biomechanics, maintain physiological movements and reduce the risk of degeneration of the adjacent segment degenerative disease [ 11 ]. With correct selection of patients and indications for lumbar TDR may have better clinical outcomes compared to the fusion [ 12 ]. It is well recognized that heavy physical work may contribute to the development of degenerative changes in the lumbar spine segments [ 13 ]. This leads to acceleration of degenerative disk disease with the development of clinical compression symptoms, which reduces the preoperative workload of Railway workers [ 14 ]. The ability to maintain tolerance to intense physical activity with the restoration of previous professional activities is important for this category of patients [ 15 ]. In this study, we conducted a prospective, blinded, and randomized trial to determine 1-year results of clinical effectiveness and return to work rate after lumbar total disk replacement and microsurgical lumbar discectomy in railway workers with lumbar degenerative disk disease. Materials and Methods Patient Population This prospective randomized study was approved by the ethics committee of ( Blinded ) (No.1, dated February 24, 2021), and all patients provided their written informed consent to participate in this research. The analysis of the clinical material was carried out in accordance with the principles of the Declaration of Helsinki. The patients data used to support the findings of this study are restricted by the Ethics Committee of ( Blinded ) in order to protect of the patient privacy. Data are available from the corresponding author (VAB) for researchers who meet the criteria for access to confidential data. The trial was registered with the Unified State Information System for Recording the Results of Research, Development and Technological Works for Civil Purposes (USISR RDTWCP; http://rosrid.ru/ ), and its clinical trial registration no 622011400059-4. The study was conducted at the Center for Neurosurgery of the ( Blinded ) and enrolled 75 consecutive patients, ages 25–35, including 26 women (34.7%) and 49 men (65.3%) who underwent lumbar spine surgery between March 2021 and August 2022 (Fig. 1 ). The diagnoses treated included LDH. The surgical procedures involved a one-level TDR or MLD. Patients were excluded from the study if they met any of the following criteria: unable to read or understand the study protocol, had a contraindication to study medications or anesthesia, had a condition that could impact the required neurological assessments (e.g., insulin-dependent diabetes mellitus, neuropathy in the lower extremities, demyelinating disease, or history of stroke), had hepatic or renal failure, used opioids chronically, had an active history of substance abuse, were pregnant, had a deficit in hearing or vision that prevented study assessments, had a history of cognitive impairment or dementia with a baseline score of less than 23 on the Mini-Mental State Examination (MMSE), had a history of anxiety and/ or depression according to the Hospital Anxiety and Depression Scale (≥ 11 points), had an American Society of Anesthesiologists (ASA) status greater than III, had an educational level less than grade 9, or had a history of mental illnesses. Protocol All the patients were randomly assigned to one of two treatment groups: group 1 received TDR, and group 2 received MLD. The randomization strategy was based on a computer-generated randomization sequence ( http://www.randomizer.org ). The random assignment of each patient was determined by opening a sealed envelope just prior to surgery. Surgical techniques One primary surgeon (V.A.B.) performed TDR and MLD. Two study groups were identified: in the TDR-group (n = 37) we used total discectomy with bilateral foraminotomy and mandatory resection of the posterior longitudinal ligament from the left-sided pararectal extraperitoneal approach was performed. A prosthesis «М6-L» (Spinal Kinetics, Switzerland, no conflict interest) was used, consisting of ultra-high-molecular-weight polyethylene fibers wound in multiple redundant layers around a polycarbonate urethane polymer core and through titanium alloy endplates with keels to provide fixation to the superior and inferior vertebral bodies. In the MLD-group (n = 38), intervention was performed from the interlaminar intermuscular approach, ligamentum flavum was excised, after dissection of adhesions, the microsurgical discectomy was performed. Nerve root pulsation and its free displacement indicated adequate discectomy. Inclusion сriteria • persistent radicular pain syndrome, resistant to conservative therapy for 6–8 weeks (as a conservative treatment using non-narcotic analgesics, muscle relaxants, vitamins, epidural blockade with steroids, physiotherapy); • degenerative disease of the lumbar spine IVD in the segments L4-L5 or L5-S1 without disk migrations on preoperative MRI: type «root compression» according to van Rijn classification system and «lumbar disk extrusion» according to Combined Task Force (CTF) classification system [ 16 ]; • I-II grade of IVD according to Pfirrmann C. [ 17 ]; • I-II grade of facet joints (FJ) according to Fujiwara A. [ 18 ]; • preservation of the height of the interbody space – more than 50% of the overlying one; • no signs of segmental instability in the functional spinal unite (FSU) – Slip Percentage > 15%, Dynamic Slip > 4.5 mm, Dynamic Segmental Angle > 20 0 (L4-L5) and > 25 0 (L5-S1); • no signs of posterior osteophytes. Exclusion сriteria • degenerative disease of the lumbar spine IVD in the segments L4-L5 or L5-S1 with disk migrations on preoperative MRI; • type «no root compression, possibly no root compression, indeterminate root compression, possible root compression» according to van Rijn classification system and «normal lumbar disk, focal protrusion, broad-based protrusion» according to Combined Task Force (CTF) classification system [ 16 ]; • previously lumbar spinal surgery; • osteoporosis; • a competing pathological process in the lumbar spine (traumatic injuries, systemic connective tissue diseases, infectious and inflammatory diseases, tumor lesions, etc.); • segmental instability; • spondylarthrosis; • decrease in the height of the interbody space; • positive test with FJ blokade; • spinal stenosis; • refusal to participate in the study. Data analyzed The demographic parameters obtained through a review of medical records included sex, age, body mass index. All patients were assessed when they checked in for surgery, at the time of hospital discharge, and at follow-up appointments 3, 6, and 12 months after surgery. Patients completed a questionnaire at each follow-up appointment yielding their Oswestry Disability Index (ODI) score. The ODI score was considered the primary outcome. Pain severity was evaluated using the visual analog scale (VAS). Quality of life according studying according to SF-36. The criterion for the restoration of working capacity was the absence of pain and neurological disorders during the performance of physical activity loads with the restoration of the previous employment. Return to Work – number of patients who returned to work at 1 year following their surgery and the number of days after surgery it took for patients to resume working. The date of the return to work was self-reported in the follow-up questionnaires. Specifics such as part-time vs full-time work and workplace restrictions were not captured. Baseline workload was self-reported at baseline in the preoperative patient questionnaire and was categorized as sedentary to very heavy based on lifting pattern as defined by the dictionary of Occupational Title ( https://occupationalinfo.org ). This study divided workloads into 3 categories: sedentary, light-moderate and heavy-very heavy. Prior to surgical intervention and at the last postoperative follow-up X-ray assessment we analyzed: (1) range of motion (ROM); (2) general lumbar lordosis (GLL). MRI was also used to evaluate pre- and postoperative changes in the lumbar spine. The analysis of data was carried out by two experts (neurosurgeon and radiologist) previously blinded to the patient's information. Statistical evaluation of expert agreement on each issue was performed using Kappa statistics (Graph Pad Software, Inc., USA). Statistical analysis Statistical processing of the study results study was carried out on a personal computer using the Statistica 13.5 program. The necessary statistical power of the study and the number of cases in each group were calculated, and the ODI score was considered the main indicator of functional outcome. A minimum of 37 cases was needed in each group to achieve 80% statistical power, with P < 0.05 as the 2-tailed level of significance indicating achievement of the minimum clinically significant 10-point difference in ODI score (standard deviation = 15). The character of the distribution of signs was evaluated by the Shapiro — Wilk, Kolmogorov — Smirnov and Lilliefors tests for normality. Considering the presence of statistically significant differences according to these tests ( p < 0.05), the distribution was considered to be different from normal. In this regard, the criteria of nonparametric statistics were used to assess the significance of the differences in the samples. The obtained results are presented by the median, the values of the 1st and 3rd quartiles — Me (Q 25 ; Q 75 ). For a comparative analysis of the obtained values, the Mann — Whitney U—test and the Wilcoxon criterion, the χ 2 criterion for binomial signs were used. Results 75 respondents (49 men and 26 women) who were operated on with either TDR and MLD were analyzed. General information about the study groups of patients is shown in Table 1 . A comparative analysis found that the groups were representative of all the analyzed features. Comparative intergroup analysis of preoperative clinical data demonstrated no statistically significant differences for all parameters (p > 0.05). Table 1 – General data of the studied patients Criterion TDR Group ( n = 37) MLD Group ( n = 38) p Age, yrs, Me (Q 25 ; Q 75 ) 29 (23; 36) 27 (22; 38) 0.37 Sex Males, n (%) 25 (67.5) 24 (63.1) 0.68 Females, n (%) 12 (32.5) 14 (36.9) Operation level L4-L5, n (%) 18 (48.6) 17 (44.7) 0.73 L5-S1, n (%) 19 (51.4) 21 (55.3) ASA score, n (%) I 12 (32.5) 10 (26.3) 0.42 II 14 (37.8) 16 (42.1) III 11 (29.7) 12 (31.6) Smoking, n, % 10 (27) 8 (21.1) 0.54 Pain syndrome, VAS, mm, Me (Q 25 ; Q 75 ) Lumbar spine 82 (75;84) 82 (78;88) 0.15 Lower limbs 89 (83;92) 92 (85;100) 0.06 Preoperative neurological symptoms Motor deficit, n (%) 2 (5.4) 3 (7.9) 0.17 Sensory deficit, n (%) 23 (62.2) 22 (57.9) Reflex changes, n (%) 28 (75.7) 27 (71.1) Primary presenting complain Back pain, n (%) 18 (48.6) 19 (50) 0.92 Radiculopathy, n (%) 37 (100) 38 (100) Functional state according to ODI score, Me (Q 25 ; Q 75 ) 82 (74; 88) 80 (68; 88) 0.15 SF-36, score, Me (Q 25 ; Q 75 ) Physical component score 24.51 (19.84; 26.18) 23.18 (20.56; 25.99) 0.69 Mental component score 23.44 (21.22; 27.69) 23.57 (20.71; 26.72) 0.92 Preoperative workload Sedentary, n, % 5 (13.5) 4 (10.5) 0.69 Light-medium, n, % 15 (40.6) 18 (47.4) 0.55 Heavy-very heavy, n, % 17 (45.9) 16 (42.1) 0.73 An intergroup comparison of intraoperative parameters and the specificity of the course of the postoperative period in the studied patients showed statistically lower duration of surgery in MLD group compared with TDR group: 50 (40;65) min versus 90 (75;135) min, respectively (p = 0.01); the volume of blood loss 35 (20;50) ml versus 75 (50;100) ml, respectively (p = 0.03). At the same time, comparable parameters were registered between MLD group and TDR group: time to mobilization 1 (1; 2) day versus 1 (1; 2) days, respectively (p = 0.96); the duration of inpatient treatment 2 (2;3) days versus 2 (1;3) days, respectively (p = 0.14). VAS scores (Fig. 2 ) indicated considerable back pain and leg pain relief immediately after surgery (p < 0.01) and remaining low thereafter. There was no difference at time point between back pain (discharge, p = 0.28; 3 months, p = 0.61) and leg pain scores (discharge, p = 0.45; 3 months, p = 0.58; 6 months, p = 0.06). There was significantly lower back pain (6 months, p = 0.005; 12 months, p < 0.001) and leg pain (12 months, p < 0.001) in the TDR group than in the MLD group. At discharge, ODI scores indicated highly significant improvement in patients’ quality of life in both groups (p < 0.01) (Fig. 3 ). There was no difference at time point in the patients’ ODI scores (discharge, p = 0.96; 3 months, p = 0.65). Intergroup comparison showed difference in the patients’ ODI scores across groups at 6 and 12 months after TDR group than in the MLD group (p = 0.01, p < 0.001, respectively). Intergroup comparison showed better outcomes after TDR in comparison to MLD according to SF-36 at 6 and 12 months after surgery (Fig. 4 ). There was no difference at time point between PCS (discharge, p = 0.35; 3 months, p = 0.10) and MCS (discharge, p = 0.13). There was significantly higher PCS (6 months, p < 0.001; 12 months, p < 0.001) and MCS (3 months, p = 0.01; 6 months, p < 0.001; 12 months, p < 0.001) in the TDR group than in the MLD group. The inter-observer agreement for each of the measured radiological parameter was good and excellent according to Kappa statistics: ROM pre-operatively – 0.729 ± 0.142 (0.582–1.000, 95% CI), as well as post-operatively – 0.908 ± 0.082 (0.740–1.000, 95% CI); GLL pre-operatively – 0.908 ± 0.082 (0.740–1.000, 95% CI), as well as post-operatively – 0.818 ± 0.120 (0.584–1.000, 95% CI). The analysis showed a change in ROM from 5.9 (5.3; 6.5) 0 to 8.3 (7.3;8.9) 0 (p < 0.001) in TDR group t and from 6.0 (5.1;6.7) 0 to 5.75 (5.1;6.3) 0 (p = 0.04) in MLD group. There was no difference of the ROM before operation (p = 0.88). Intergroup comparison showed better ROM across groups at 12 months after TDR group than in the MLD group (p < 0.001). At 12 months registered change of GLL from 38 (34;42) 0 to 39 (35;43) 0 (p = 0.04) in TDR group and from 36 (32;40) 0 to 35 (31;41) 0 (p = 0.98) in MLD group. There was no difference of the GLL before operation (p = 0.29). Intergroup comparison showed difference of the GLL across groups at last follow-up after TDR group than in the MLD group (p = 0.03). After the operation, the patient began an active rehabilitation program, the same in both groups. In the 3rd week after the surgery, a Home exercises were used; in the 5th week, Low-intensity exercise started; in the 7th week, High-intensity exercise restarted. 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) (Table 2 ). Table 2 – Comparative analysis of perioperative complications and causes of reoperations in patients of the study groups Parameter TDR Group ( n = 37) MLD Group ( n = 38) p Surgery complication Nerve root injury - 1 0.47 Surgical site infection 1 1 Postoperative hematoma 1 1 Spondylodiscitis - 1 Transient partial urination disturbance - 1 Retrograde ejaculation 1 - Reoperation Adjacent segment degeneration 1 1 0.04 Herniation recurrence - 3 Segmental instability - 1 Severe facet syndrome 1 3 Table 3 displays median time to return to work for the 3 workload groups based on the procedure. The sedentary, light-moderate and heavy-very heavy groups had no difference time to return to work after TDR and MLD group (p < 0.05). Table 3 – Time to return to work (in days) and return to work rate at 1 year stratified by workload and surgical procedure Criterion TDR Group ( n = 37) MLD Group ( n = 38) p Time to return to work Sedentary, Me (Q 25 ; Q 75 ) 44 (37;58) 40 (35;53) 0.74 Light-medium, Me (Q 25 ; Q 75 ) 56 (46;67) 51 (42; 64) 0.41 Heavy-very heavy, Me (Q 25 ; Q 75 ) 72 (64;91) 70 (61;90) 0.83 Return to work rate Sedentary, n, % 5 (100) 3 (75) 0.23 Light-medium, n, % 15 (100) 11 (61.1) 0.006 Heavy-very heavy, n, % 15 (88.2) 9 (56.25) 0.01 The overall return to work rate in this study for TDR group was 94.6% and for MLD group was 60.5% − 35 patients and 23 patients, respectively, returned within 1 year after surgery. In a comparative analysis, depending on the workload, a statistically significantly higher return to work rate was found after TDR compared with MLD in light-moderate and heavy-very heavy groups (p < 0.05). Discussion High intensity workloads on the spine experienced by railway workers contribute to formation and acceleration of degeneration processes in the lumbar segments [ 14 ]. This leads to the formation of LDH, deformities and segmental instability associated with persistent radicular neurological manifestations requiring surgical treatment [ 15 ]. MLD has relatively high clinical efficacy in the population due to the minimal trauma of the surgical procedure [ 3 ]. It has been established that limited discectomy increases the risk of recurrent disc herniation, while more total removal of the IVD is associated with collapse of the interbody space, foraminal stenosis with compression of the nerve roots, or symptomatic facet syndrome [ 19 ]. Fusion surgery is common procedure of surgical treatment various lumbar spine degenerative diseases [ 20 ]. At the same time, rigid fixation of the operated segments, are associated with limited mobility of the lumbar spine and changes in the kinematics of the spine as a whole [ 21 ]. The use of artificial prosthesis that imitates the biomechanics of a normal IVD made it possible to achieve good clinical results and maintain physiological mobility to respondents in the shortest possible time [ 22 ]. TDR techniques have been associated with early functional recovery, better clinical outcome and decreased postoperative pain than fusion surgery [ 23 ]. Railway workers – a cohort of patients with a high preoperative level of physical activity, motivated by a rapid professional recovery [ 14 ]. Maintaining performance is the dominant reason for preventing the development of psychological, social and financial consequences [ 24 ]. To our knowledge, this is the first study to report the rate and the time to return to work based on workload intensity in railway workers who have undergone one-level TDR versus MLD. Studies describing recovery as a function of workload intensity are sparse. According to Singh S. et al. [ 25 ] 1 year after non-fusion surgery return to work rate were sedentary (87%), light-medium (86%) and heavy-very heavy (80%). Median time to return to work were sedentary (41 days), light-medium (52 days) and heavy-very heavy (71 days). Significant physical activity at work prolongs return to work and duration of disability [ 26 ]. This influences spinal surgeons' choice of recovery recommendations to withstand workloads depending on the type of surgery and workplace requirements [ 27 ]. For non-fusion procedures, most surgeons recommended 2–6 weeks off work before returning to a sedentary to light-moderate workload job and 7–12 weeks off work for a heavy-very heavy workload job [ 25 ]. To our knowledge, this is the first study to compare TDR and MLD procedures on clinical outcomes and recovery time in Railway workers. In addition, in the specialized literature we have not encountered studies comparing the results of TDR and MLD procedures in patients with single-level LDH. TDR and MLD procedures for single-level lumbar disk herniation had comparable number of surgical complications (p = 0.47) and time to return to work (p > 0.05). The use of TDR compared favorably to MLD with improved last follow up ODI (p < 0.001), back pain (p < 0.001), leg pain (p < 0.001), SF-36 (p < 0.001), as well as restoration of ROM (p < 0.001), preservation of GLL (p < 0.001) and lower rate of additional surgery procedures (p = 0.04). 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 (p < 0.05). Limitation The main limitations of this study were: (1) single center nature of the study; (2) this study primarily composed of a unique, relatively homogeneous population of railway workers with risky strenuous labor responsibilities; (3) relatively short follow-up period of 1 year; (4) we did not analyze any other decompression and decompression-stabilization techniques; (5) we included only patients who were working before surgery since this was the only group for which we could obtain the workload information needed to stratify the 3 cohorts, our results may not be applicable to patients who were not working pre-operatively; (6) information on post-operative rehabilitation and overall post-operative management were not available so the effect of rehabilitation could not be included. Despite these limitations, the strengths of the study include its 1-year follow-up on a large population of patients, recruited randomly, with a single diagnosis, treated by a single team without numerous confounding variables. Conclusions The results showed that lumbar TDR and MLD are highly effective in improving clinical results 1 year follow-up in railway workers. However, the TDR technique has statistically significant advantages in terms of the dynamics of the level of leg pain, restoration of the functional state and quality of life compared to MLD at last follow up period. In addition, after lumbar TDR, there was a higher return to work rate in light-moderate and heavy-very heavy groups, which is most likely associated with restoration of segmental mobility, preservation of global lumbar lordosis and lower reoperations compared with MLD. Declarations Ethical Approval The study was approved by the Ethics Committee of Irkutsk State Medical University, protocol No.2, dated April 19, 2020. Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Authors' contributions Each author made significant individual contributions to this manuscript. VAB (0000-0003-4349-7101)*, AAK (0000-0002-6059-4344)* and MAA (0000-0002-3190-2395)* were the main contributors to the drafting of the manuscript. VAB, AAK and YYP (0000-0001-7076-571X) performed the surgery, and patient follow-up, and gathered clinical data. AAK, MAA, YYP and RMY (0009-0002-7165-5373) evaluated the data from the statistical analysis. VAB, AAK, MAA, YYP and RMY performed the literature search and review of the manuscript, and contributed to the intellectual concept of the study. *ORCID (Open Researcher and Contributor ID). 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Spine 26(17):1873-1878. https://doi.org/10.1097/00007632-200109010-00011 Fujiwara A, Lim TH, An HS, Tanaka N, Jeon CH, Andersson GB, Haughton VM (2000) The Effect of Disc Degeneration and Facet Joint Osteoarthritis on the Segmental Flexibility of the Lumbar Spine. Spine 25(23): 3036-3044. https://doi.org/10.1097/00007632-200012010-00011 Belykh E, Krutko AV, Baykov ES, Giers MB, Preul MC, Byvaltsev VA (2017) Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J 17(3):390-400. https://doi.org/10.1016/j.spinee.2016.10.011 Bamps S, Raymaekers V, Roosen G, Put E, Vanvolsem S, Achahbar SE, Meeuws S, Wissels M, Plazier M (2023) Lateral Lumbar Interbody Fusion (Direct Lateral Interbody Fusion/Extreme Lateral Interbody Fusion) versus Posterior Lumbar Interbody Fusion Surgery in Spinal Degenerative Disease: A Systematic Review. World Neurosurg 171:10-18. https://doi.org/10.1016/j.wneu.2022.12.033 Toivonen LA, Mäntymäki H, Häkkinen A, Kautiainen H, Neva MH (2022) Postoperative Sagittal Balance Has Only a Limited Role in the Development of Adjacent Segment Disease After Lumbar Spine Fusion for Degenerative Lumbar Spine Disorders: A Subanalysis of the 10-year Follow-up Study. Spine (Phila Pa 1976) 47(19):1357-1361. https://doi.org/10.1097/BRS.0000000000004400 Byvaltsev VA, Kalinin AA, Aliyev MA, Shepelev VV, Pestryakov YY, Ivanov M (2021) Clinical-Instrumental Results and Analysis of Functional Activity Restoration in Professional Athletes After Lumbar Total Disk Replacement. World Neurosurg 151:e1069-e1077. https://doi.org/10.1016/j.wneu.2021.05.066 Li YZ, Sun P, Chen D, Tang L, Chen CH, Wu AM (2020) Artificial Total Disc Replacement Versus Fusion for Lumbar Degenerative Disc Disease: An Update Systematic Review and Meta-Analysis. Turk Neurosurg 30(1):1-10. https://doi.org/10.5137/1019-5149.JTN.24799-18.2 Ji FL, Liu ZM, Liu ZS, Zou JF, Yu WL, Li HM, Li J, Kong LM, Jiang Q (2018) [Mental health status in railway female workers and its occupational influencing factors]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 36(2):102-105. Chinese. https://doi.org/10.3760/cma.j.issn.1001-9391.2018.02.006 Singh S, McIntosh G, Dea N, Hall H, Paquet J, Abraham E, Bailey CS, Weber MH, Johnson MG, Nataraj A, Glennie RA, Attabib N, Kelly A, Rampersaud YR, Manson N, Phan P, Rachevitz M, Thomas K, Fisher C, Charest-Morin R (2022) Effects of Workload on Return to Work After Elective Lumbar Spine Surgery. Global Spine J 20:21925682221109558. https://doi.org/10.1177/21925682221109558 Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH (2013) Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev 2013(8):CD001822. https://doi.org/10.1002/14651858.CD001822.pub3 Russo F, Papalia GF, Vadalà G, Fontana L, Iavicoli S, Papalia R, Denaro V (2021) The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 18(23):12614. https://doi.org/10.3390/ijerph182312614 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3908015","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":270041613,"identity":"3bdf4e32-dc37-4b11-8bf1-d7864e28d972","order_by":0,"name":"Vadim A. Byvaltsev","email":"data:image/png;base64,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","orcid":"","institution":"Irkutsk State Medical University","correspondingAuthor":true,"prefix":"","firstName":"Vadim","middleName":"A.","lastName":"Byvaltsev","suffix":""},{"id":270041614,"identity":"0856848a-aac1-4531-b5c4-8065bb214227","order_by":1,"name":"Andrei A. Kalinin","email":"","orcid":"","institution":"Irkutsk State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Andrei","middleName":"A.","lastName":"Kalinin","suffix":""},{"id":270041615,"identity":"6edcfce3-30e7-4c74-990b-895af6045f73","order_by":2,"name":"Yurii Ya. Pestryakov","email":"","orcid":"","institution":"Irkutsk State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yurii","middleName":"Ya.","lastName":"Pestryakov","suffix":""},{"id":270041616,"identity":"b19fe18a-4738-4537-99cd-15b15010f241","order_by":3,"name":"Ravshan M. Yuldashev","email":"","orcid":"","institution":"Republican Specialized Scientific and Practical Medical Center for Neurosurgery of the Ministry of Health of the Republic of Uzbekistan","correspondingAuthor":false,"prefix":"","firstName":"Ravshan","middleName":"M.","lastName":"Yuldashev","suffix":""},{"id":270041617,"identity":"b29d2aaf-6f96-439d-a4eb-84d2243bdad6","order_by":4,"name":"Marat Aliyev","email":"","orcid":"","institution":"Asfendiyarov Kazakh National Medical University","correspondingAuthor":false,"prefix":"","firstName":"Marat","middleName":"","lastName":"Aliyev","suffix":""}],"badges":[],"createdAt":"2024-01-29 05:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3908015/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3908015/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50511690,"identity":"a758a522-60b1-47e8-95d9-7a568f2e857d","added_by":"auto","created_at":"2024-02-01 16:15:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":228129,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of study\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3908015/v1/85a2d54bf8e5ad4794c94e26.png"},{"id":50511688,"identity":"1b105af0-fea8-4ed2-8590-fd6054ca9190","added_by":"auto","created_at":"2024-02-01 16:15:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":229228,"visible":true,"origin":"","legend":"\u003cp\u003ePain visual analog scale (VAS) scores before operation, at discharge, and 3, 6, and 12 months postoperatively in the 2 groups of prospective study (n=75), shown as the median and interquartile range. A VAS score of 0 indicates absence of pain; 100 is the highest possible level of pain intensity\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3908015/v1/5024e3ff0d8a70ced78e76a5.png"},{"id":50513070,"identity":"be0a2bed-1610-4fa7-b2fd-1bc0ddf65062","added_by":"auto","created_at":"2024-02-01 16:23:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":133368,"visible":true,"origin":"","legend":"\u003cp\u003eOswestry Disability Index (ODI) scores before operation, at discharge, and 3, 6, and 12 months postoperatively in the 2 groups in the prospective study (n=75), shown as the median and interquartile range. The lowest ODI score corresponds to the best functional state\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3908015/v1/ed1abe765216d135057ff619.png"},{"id":50511691,"identity":"c28d7936-38a5-4995-bde4-5e81702485b4","added_by":"auto","created_at":"2024-02-01 16:15:49","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":408334,"visible":true,"origin":"","legend":"\u003cp\u003eSF-36 (physical component score (PCS) and mental component score (MCS)) scores before operation, at discharge, and 3, 6, and 12 months postoperatively in the 2 groups in the prospective study (n=75), shown as the median and interquartile range. The highest SF-36 score corresponds to the best quality of life\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-3908015/v1/79f7edec4357d85d21075833.png"},{"id":50958033,"identity":"7c092a89-9e62-4a2f-8a25-7a94df6b027a","added_by":"auto","created_at":"2024-02-10 21:22:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1308813,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3908015/v1/752f981c-d96b-4c93-93da-d8efa26fb9d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eClinical Effectiveness and Return to Work Rate After Lumbar Total Disk Replacement and Microsurgical Lumbar Discectomy in Railway Workers: a Prospective Randomized Controlled Trial\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eLow back pain and sciatica are among the leading causes of disability in the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A common cause of lower back and leg pain, is lumbar disc herniation (LDH) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn cases of ineffectiveness of conservative measures for resolve patient clinical symptoms, a microsurgical discectomy using is used to remove the herniated intervertebral disk (IVD) and decompress the symptomatic nerve [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It was found that after lumbar discectomy have risk for symptom recurrence, loss of disc height with postoperative radiculopathy and reoperation associated with recurrent herniation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. So, high rate of LDH patients at 1 year after spinal surgery expressed unhappiness with the level of pain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRigid spinal fusion is frequently considered as one of the preferred methods of surgical treatment for patients with lumbar degenerative diseases [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Fusion techniques reduce pain by restricting the abnormal motion, reducing instability, and restoring spinal alignment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, rigid fixation of a spinal segment is considered to be one of the risk factors that may lead to accelerated degeneration of the adjacent level associated with increase intradiscal pressure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe lumbar total disk replacement (TDR) in surgical treatment of degenerative disk disease is a known alternative to fusion interventions in specific cases [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This technology preserve of natural biomechanics, maintain physiological movements and reduce the risk of degeneration of the adjacent segment degenerative disease [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. With correct selection of patients and indications for lumbar TDR may have better clinical outcomes compared to the fusion [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is well recognized that heavy physical work may contribute to the development of degenerative changes in the lumbar spine segments [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This leads to acceleration of degenerative disk disease with the development of clinical compression symptoms, which reduces the preoperative workload of Railway workers [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The ability to maintain tolerance to intense physical activity with the restoration of previous professional activities is important for this category of patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we conducted a prospective, blinded, and randomized trial to determine 1-year results of clinical effectiveness and return to work rate after lumbar total disk replacement and microsurgical lumbar discectomy in railway workers with lumbar degenerative disk disease.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003ePatient Population\u003c/h2\u003e\n \u003cp\u003eThis prospective randomized study was approved by the ethics committee of (\u003cstrong\u003eBlinded\u003c/strong\u003e) (No.1, dated February 24, 2021), and all patients provided their written informed consent to participate in this research. The analysis of the clinical material was carried out in accordance with the principles of the Declaration of Helsinki. The patients data used to support the findings of this study are restricted by the Ethics Committee of (\u003cstrong\u003eBlinded\u003c/strong\u003e) in order to protect of the patient privacy. Data are available from the corresponding author (VAB) for researchers who meet the criteria for access to confidential data.\u003c/p\u003e\n \u003cp\u003eThe trial was registered with the Unified State Information System for Recording the Results of Research, Development and Technological Works for Civil Purposes (USISR RDTWCP; \u003cspan\u003e\u003cspan\u003ehttp://rosrid.ru/\u003c/span\u003e\u003c/span\u003e), and its clinical trial registration no 622011400059-4. The study was conducted at the Center for Neurosurgery of the (\u003cstrong\u003eBlinded\u003c/strong\u003e) and enrolled 75 consecutive patients, ages 25\u0026ndash;35, including 26 women (34.7%) and 49 men (65.3%) who underwent lumbar spine surgery between March 2021 and August 2022 (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e). The diagnoses treated included LDH. The surgical procedures involved a one-level TDR or MLD.\u003c/p\u003e\n \u003cp\u003ePatients were excluded from the study if they met any of the following criteria: unable to read or understand the study protocol, had a contraindication to study medications or anesthesia, had a condition that could impact the required neurological assessments (e.g., insulin-dependent diabetes mellitus, neuropathy in the lower extremities, demyelinating disease, or history of stroke), had hepatic or renal failure, used opioids chronically, had an active history of substance abuse, were pregnant, had a deficit in hearing or vision that prevented study assessments, had a history of cognitive impairment or dementia with a baseline score of less than 23 on the Mini-Mental State Examination (MMSE), had a history of anxiety and/ or depression according to the Hospital Anxiety and Depression Scale (\u0026ge;\u0026thinsp;11 points), had an American Society of Anesthesiologists (ASA) status greater than III, had an educational level less than grade 9, or had a history of mental illnesses.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003eProtocol\u003c/h2\u003e\n \u003cp\u003eAll the patients were randomly assigned to one of two treatment groups: group 1 received TDR, and group 2 received MLD. The randomization strategy was based on a computer-generated randomization sequence (\u003cspan\u003e\u003cspan\u003ehttp://www.randomizer.org\u003c/span\u003e\u003c/span\u003e). The random assignment of each patient was determined by opening a sealed envelope just prior to surgery.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003eSurgical techniques\u003c/h2\u003e\n \u003cp\u003eOne primary surgeon (V.A.B.) performed TDR and MLD.\u003c/p\u003e\n \u003cp\u003eTwo study groups were identified: in the TDR-group (n\u0026thinsp;=\u0026thinsp;37) we used total discectomy with bilateral foraminotomy and mandatory resection of the posterior longitudinal ligament from the left-sided pararectal extraperitoneal approach was performed. A prosthesis \u0026laquo;М6-L\u0026raquo; (Spinal Kinetics, Switzerland, no conflict interest) was used, consisting of ultra-high-molecular-weight polyethylene fibers wound in multiple redundant layers around a polycarbonate urethane polymer core and through titanium alloy endplates with keels to provide fixation to the superior and inferior vertebral bodies. In the MLD-group (n\u0026thinsp;=\u0026thinsp;38), intervention was performed from the interlaminar intermuscular approach, ligamentum flavum was excised, after dissection of adhesions, the microsurgical discectomy was performed. Nerve root pulsation and its free displacement indicated adequate discectomy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003eInclusion сriteria\u003c/h2\u003e\n \u003cp\u003e\u0026bull; persistent radicular pain syndrome, resistant to conservative therapy for 6\u0026ndash;8 weeks (as a conservative treatment using non-narcotic analgesics, muscle relaxants, vitamins, epidural blockade with steroids, physiotherapy);\u003c/p\u003e\n \u003cp\u003e\u0026bull; degenerative disease of the lumbar spine IVD in the segments L4-L5 or L5-S1 without disk migrations on preoperative MRI: type \u0026laquo;root compression\u0026raquo; according to van Rijn classification system and \u0026laquo;lumbar disk extrusion\u0026raquo; according to Combined Task Force (CTF) classification system [\u003cspan\u003e16\u003c/span\u003e];\u003c/p\u003e\n \u003cp\u003e\u0026bull; I-II grade of IVD according to Pfirrmann C. [\u003cspan\u003e17\u003c/span\u003e];\u003c/p\u003e\n \u003cp\u003e\u0026bull; I-II grade of facet joints (FJ) according to Fujiwara A. [\u003cspan\u003e18\u003c/span\u003e];\u003c/p\u003e\n \u003cp\u003e\u0026bull; preservation of the height of the interbody space \u0026ndash; more than 50% of the overlying one;\u003c/p\u003e\n \u003cp\u003e\u0026bull; no signs of segmental instability in the functional spinal unite (FSU) \u0026ndash; Slip Percentage\u0026thinsp;\u0026gt;\u0026thinsp;15%, Dynamic Slip\u0026thinsp;\u0026gt;\u0026thinsp;4.5 mm, Dynamic Segmental Angle\u0026thinsp;\u0026gt;\u0026thinsp;20\u003csup\u003e0\u003c/sup\u003e (L4-L5) and \u0026gt;\u0026thinsp;25\u003csup\u003e0\u003c/sup\u003e (L5-S1);\u003c/p\u003e\n \u003cp\u003e\u0026bull; no signs of posterior osteophytes.\u003c/p\u003e\u003cbr\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\"\u003e\n \u003ch2\u003eExclusion сriteria\u003c/h2\u003e\u0026bull; degenerative disease of the lumbar spine IVD in the segments L4-L5 or L5-S1 with disk migrations on preoperative MRI;\u003cp\u003e\u0026bull; type \u0026laquo;no root compression, possibly no root compression, indeterminate root compression, possible root compression\u0026raquo; according to van Rijn classification system and \u0026laquo;normal lumbar disk, focal protrusion, broad-based protrusion\u0026raquo; according to Combined Task Force (CTF) classification system [\u003cspan\u003e16\u003c/span\u003e];\u003c/p\u003e\n \u003cp\u003e\u0026bull; previously lumbar spinal surgery;\u003c/p\u003e\n \u003cp\u003e\u0026bull; osteoporosis;\u003c/p\u003e\n \u003cp\u003e\u0026bull; a competing pathological process in the lumbar spine (traumatic injuries, systemic connective tissue diseases, infectious and inflammatory diseases, tumor lesions, etc.);\u003c/p\u003e\n \u003cp\u003e\u0026bull; segmental instability;\u003c/p\u003e\n \u003cp\u003e\u0026bull; spondylarthrosis;\u003c/p\u003e\n \u003cp\u003e\u0026bull; decrease in the height of the interbody space;\u003c/p\u003e\n \u003cp\u003e\u0026bull; positive test with FJ blokade;\u003c/p\u003e\n \u003cp\u003e\u0026bull; spinal stenosis;\u003c/p\u003e\n \u003cp\u003e\u0026bull; refusal to participate in the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eData analyzed\u003c/h2\u003e\n \u003cp\u003eThe demographic parameters obtained through a review of medical records included sex, age, body mass index.\u003c/p\u003e\n \u003cp\u003eAll patients were assessed when they checked in for surgery, at the time of hospital discharge, and at follow-up appointments 3, 6, and 12 months after surgery. Patients completed a questionnaire at each follow-up appointment yielding their Oswestry Disability Index (ODI) score. The ODI score was considered the primary outcome. Pain severity was evaluated using the visual analog scale (VAS). Quality of life according studying according to SF-36.\u003c/p\u003e\n \u003cp\u003eThe criterion for the restoration of working capacity was the absence of pain and neurological disorders during the performance of physical activity loads with the restoration of the previous employment.\u003c/p\u003e\n \u003cp\u003eReturn to Work \u0026ndash; number of patients who returned to work at 1 year following their surgery and the number of days after surgery it took for patients to resume working. The date of the return to work was self-reported in the follow-up questionnaires. Specifics such as part-time vs full-time work and workplace restrictions were not captured. Baseline workload was self-reported at baseline in the preoperative patient questionnaire and was categorized as sedentary to very heavy based on lifting pattern as defined by the dictionary of Occupational Title (\u003cspan\u003e\u003cspan\u003ehttps://occupationalinfo.org\u003c/span\u003e\u003c/span\u003e). This study divided workloads into 3 categories: sedentary, light-moderate and heavy-very heavy.\u003c/p\u003e\n \u003cp\u003ePrior to surgical intervention and at the last postoperative follow-up X-ray assessment we analyzed: (1) range of motion (ROM); (2) general lumbar lordosis (GLL). MRI was also used to evaluate pre- and postoperative changes in the lumbar spine.\u003c/p\u003eThe analysis of data was carried out by two experts (neurosurgeon and radiologist) previously blinded to the patient\u0026apos;s information. Statistical evaluation of expert agreement on each issue was performed using Kappa statistics (Graph Pad Software, Inc., USA).\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eStatistical processing of the study results study was carried out on a personal computer using the Statistica 13.5 program. The necessary statistical power of the study and the number of cases in each group were calculated, and the ODI score was considered the main indicator of functional outcome. A minimum of 37 cases was needed in each group to achieve 80% statistical power, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as the 2-tailed level of significance indicating achievement of the minimum clinically significant 10-point difference in ODI score (standard deviation\u0026thinsp;=\u0026thinsp;15).\u003c/p\u003e\n \u003cp\u003eThe character of the distribution of signs was evaluated by the Shapiro \u0026mdash; Wilk, Kolmogorov \u0026mdash; Smirnov and Lilliefors tests for normality. Considering the presence of statistically significant differences according to these tests (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05), the distribution was considered to be different from normal. In this regard, the criteria of nonparametric statistics were used to assess the significance of the differences in the samples. The obtained results are presented by the median, the values of the 1st and 3rd quartiles \u0026mdash; Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e). For a comparative analysis of the obtained values, the Mann \u0026mdash; Whitney U\u0026mdash;test and the Wilcoxon criterion, the \u0026chi;\u003csup\u003e2\u003c/sup\u003e criterion for binomial signs were used.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e75 respondents (49 men and 26 women) who were operated on with either TDR and MLD were analyzed. General information about the study groups of patients is shown in Table \u003cspan\u003e1\u003c/span\u003e. A comparative analysis found that the groups were representative of all the analyzed features. Comparative intergroup analysis of preoperative clinical data demonstrated no statistically significant differences for all parameters (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u0026ndash; General data of the studied patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003eCriterion\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eTDR Group\u003cbr\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eMLD Group\u003cbr\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003eAge, yrs, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e29 (23; 36)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e27 (22; 38)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.37\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003eSex\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eMales, \u003cem\u003en\u003c/em\u003e (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e25 (67.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e24 (63.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e0.68\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eFemales, \u003cem\u003en\u003c/em\u003e (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e12 (32.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e14 (36.9)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003eOperation level\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eL4-L5, \u003cem\u003en\u003c/em\u003e (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e18 (48.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e17 (44.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e0.73\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eL5-S1, \u003cem\u003en\u003c/em\u003e (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e19 (51.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e21 (55.3)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003eASA score, \u003cem\u003en\u003c/em\u003e (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eI\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e12 (32.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e10 (26.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e0.42\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eII\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e14 (37.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e16 (42.1)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003eIII\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e11 (29.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e12 (31.6)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003eSmoking, \u003cem\u003en, %\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e10 (27)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e8 (21.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.54\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003ePain syndrome, VAS, mm, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eLumbar spine\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e82 (75;84)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e82 (78;88)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.15\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eLower limbs\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e89 (83;92)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e92 (85;100)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.06\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"3\"\u003ePreoperative neurological symptoms\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eMotor deficit, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2 (5.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3 (7.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e0.17\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eSensory deficit, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e23 (62.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e22 (57.9)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eReflex changes, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e28 (75.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e27 (71.1)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003ePrimary presenting complain\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eBack pain, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e18 (48.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e19 (50)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e0.92\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eRadiculopathy, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e37 (100)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e38 (100)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003eFunctional state according to ODI score, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e82 (74; 88)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e80 (68; 88)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.15\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003eSF-36, score, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003ePhysical component score\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e24.51 (19.84; 26.18)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e23.18 (20.56; 25.99)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.69\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eMental component score\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e23.44 (21.22; 27.69)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e23.57 (20.71; 26.72)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.92\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"3\"\u003ePreoperative workload\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eSedentary, n, %\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e5 (13.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e4 (10.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.69\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eLight-medium, n, %\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e15 (40.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e18 (47.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.55\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHeavy-very heavy, n, %\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e17 (45.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e16 (42.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.73\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAn intergroup comparison of intraoperative parameters and the specificity of the course of the postoperative period in the studied patients showed statistically lower duration of surgery in \u003cem\u003eMLD group\u003c/em\u003e compared with TDR group: 50 (40;65) min versus 90 (75;135) min, respectively (p\u0026thinsp;=\u0026thinsp;0.01); the volume of blood loss 35 (20;50) ml versus 75 (50;100) ml, respectively (p\u0026thinsp;=\u0026thinsp;0.03). At the same time, comparable parameters were registered between MLD group and TDR group: time to mobilization 1 (1; 2) day versus 1 (1; 2) days, respectively (p\u0026thinsp;=\u0026thinsp;0.96); the duration of inpatient treatment 2 (2;3) days versus 2 (1;3) days, respectively (p\u0026thinsp;=\u0026thinsp;0.14).\u003c/p\u003e\n\u003cp\u003eVAS scores (Fig.\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e) indicated considerable back pain and leg pain relief immediately after surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and remaining low thereafter. There was no difference at time point between back pain (discharge, p\u0026thinsp;=\u0026thinsp;0.28; 3 months, p\u0026thinsp;=\u0026thinsp;0.61) and leg pain scores (discharge, p\u0026thinsp;=\u0026thinsp;0.45; 3 months, p\u0026thinsp;=\u0026thinsp;0.58; 6 months, p\u0026thinsp;=\u0026thinsp;0.06). There was significantly lower back pain (6 months, p\u0026thinsp;=\u0026thinsp;0.005; 12 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and leg pain (12 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the TDR group than in the MLD group.\u003c/p\u003e\n\u003cp\u003eAt discharge, ODI scores indicated highly significant improvement in patients\u0026rsquo; quality of life in both groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e). There was no difference at time point in the patients\u0026rsquo; ODI scores (discharge, p\u0026thinsp;=\u0026thinsp;0.96; 3 months, p\u0026thinsp;=\u0026thinsp;0.65). Intergroup comparison showed difference in the patients\u0026rsquo; ODI scores across groups at 6 and 12 months after TDR group than in the MLD group (p\u0026thinsp;=\u0026thinsp;0.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively).\u003c/p\u003e\n\u003cp\u003eIntergroup comparison showed better outcomes after TDR in comparison to MLD according to SF-36 at 6 and 12 months after surgery (Fig.\u0026nbsp;\u003cspan\u003e4\u003c/span\u003e). There was no difference at time point between PCS (discharge, p\u0026thinsp;=\u0026thinsp;0.35; 3 months, p\u0026thinsp;=\u0026thinsp;0.10) and MCS (discharge, p\u0026thinsp;=\u0026thinsp;0.13). There was significantly higher PCS (6 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 12 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and MCS (3 months, p\u0026thinsp;=\u0026thinsp;0.01; 6 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 12 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the TDR group than in the MLD group.\u003c/p\u003e\n\u003cp\u003eThe inter-observer agreement for each of the measured radiological parameter was good and excellent according to Kappa statistics: ROM pre-operatively \u0026ndash; 0.729\u0026thinsp;\u003cspan type=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;0.142 (0.582\u0026ndash;1.000, 95% CI), as well as post-operatively \u0026ndash; 0.908\u0026thinsp;\u003cspan type=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;0.082 (0.740\u0026ndash;1.000, 95% CI); GLL pre-operatively \u0026ndash; 0.908\u0026thinsp;\u003cspan type=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;0.082 (0.740\u0026ndash;1.000, 95% CI), as well as post-operatively \u0026ndash; 0.818\u0026thinsp;\u003cspan type=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;0.120 (0.584\u0026ndash;1.000, 95% CI).\u003c/p\u003e\n\u003cp\u003eThe analysis showed a change in ROM from 5.9 (5.3; 6.5)\u003csup\u003e0\u003c/sup\u003e to 8.3 (7.3;8.9)\u003csup\u003e0\u003c/sup\u003e (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in TDR group t and from 6.0 (5.1;6.7)\u003csup\u003e0\u003c/sup\u003e to 5.75 (5.1;6.3)\u003csup\u003e0\u003c/sup\u003e (p\u0026thinsp;=\u0026thinsp;0.04) in MLD group. There was no difference of the ROM before operation (p\u0026thinsp;=\u0026thinsp;0.88). Intergroup comparison showed better ROM across groups at 12 months after TDR group than in the MLD group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eAt 12 months registered change of GLL from 38 (34;42)\u003csup\u003e0\u003c/sup\u003e to 39 (35;43)\u003csup\u003e0\u003c/sup\u003e (p\u0026thinsp;=\u0026thinsp;0.04) in TDR group and from 36 (32;40)\u003csup\u003e0\u003c/sup\u003e to 35 (31;41)\u003csup\u003e0\u003c/sup\u003e (p\u0026thinsp;=\u0026thinsp;0.98) in MLD group. There was no difference of the GLL before operation (p\u0026thinsp;=\u0026thinsp;0.29). Intergroup comparison showed difference of the GLL across groups at last follow-up after TDR group than in the MLD group (p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\n\u003cp\u003eAfter the operation, the patient began an active rehabilitation program, the same in both groups. In the 3rd week after the surgery, a Home exercises were used; in the 5th week, Low-intensity exercise started; in the 7th week, High-intensity exercise restarted.\u003c/p\u003e\n\u003cp\u003eThe analysis revealed a comparable number of symptomatic complications in both groups (p\u0026thinsp;=\u0026thinsp;0.47), with a greater frequency of reoperations in the follow-up period in MLD group in comparison TDR group (p\u0026thinsp;=\u0026thinsp;0.04) (Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u0026ndash; Comparative analysis of perioperative complications and causes of reoperations in patients of the study groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003eParameter\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eTDR Group\u003cbr\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eMLD Group\u003cbr\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003eSurgery complication\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eNerve root injury\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e-\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"6\"\u003e0.47\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eSurgical site infection\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003ePostoperative hematoma\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eSpondylodiscitis\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e-\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eTransient partial urination\u003cbr\u003edisturbance\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e-\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eRetrograde ejaculation\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e-\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003eReoperation\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eAdjacent segment degeneration\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e0.04\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHerniation recurrence\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e-\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eSegmental instability\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e-\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eSevere facet syndrome\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e displays median time to return to work for the 3 workload groups based on the procedure. The sedentary, light-moderate and heavy-very heavy groups had no difference time to return to work after TDR and MLD group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u0026ndash; Time to return to work (in days) and return to work rate at 1 year stratified by workload and surgical procedure\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003eCriterion\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eTDR Group\u003cbr\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eMLD Group\u003cbr\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38)\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003ep\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003eTime to return to work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eSedentary, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e44 (37;58)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e40 (35;53)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.74\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eLight-medium, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e56 (46;67)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e51 (42; 64)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.41\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHeavy-very heavy, Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e72 (64;91)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e70 (61;90)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.83\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003eReturn to work rate\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eSedentary, n, %\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e5 (100)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3 (75)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.23\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eLight-medium, n, %\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e15 (100)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e11 (61.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.006\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHeavy-very heavy, n, %\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e15 (88.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e9 (56.25)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.01\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe overall return to work rate in this study for TDR group was 94.6% and for MLD group was 60.5% \u0026minus;\u0026thinsp;35 patients and 23 patients, respectively, returned within 1 year after surgery. In a comparative analysis, depending on the workload, a statistically significantly higher return to work rate was found after TDR compared with MLD in light-moderate and heavy-very heavy groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHigh intensity workloads on the spine experienced by railway workers contribute to formation and acceleration of degeneration processes in the lumbar segments [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This leads to the formation of LDH, deformities and segmental instability associated with persistent radicular neurological manifestations requiring surgical treatment [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMLD has relatively high clinical efficacy in the population due to the minimal trauma of the surgical procedure [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It has been established that limited discectomy increases the risk of recurrent disc herniation, while more total removal of the IVD is associated with collapse of the interbody space, foraminal stenosis with compression of the nerve roots, or symptomatic facet syndrome [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFusion surgery is common procedure of surgical treatment various lumbar spine degenerative diseases [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. At the same time, rigid fixation of the operated segments, are associated with limited mobility of the lumbar spine and changes in the kinematics of the spine as a whole [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The use of artificial prosthesis that imitates the biomechanics of a normal IVD made it possible to achieve good clinical results and maintain physiological mobility to respondents in the shortest possible time [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. TDR techniques have been associated with early functional recovery, better clinical outcome and decreased postoperative pain than fusion surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRailway workers \u0026ndash; a cohort of patients with a high preoperative level of physical activity, motivated by a rapid professional recovery [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Maintaining performance is the dominant reason for preventing the development of psychological, social and financial consequences [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. To our knowledge, this is the first study to report the rate and the time to return to work based on workload intensity in railway workers who have undergone one-level TDR versus MLD.\u003c/p\u003e \u003cp\u003eStudies describing recovery as a function of workload intensity are sparse. According to Singh S. et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] 1 year after non-fusion surgery return to work rate were sedentary (87%), light-medium (86%) and heavy-very heavy (80%). Median time to return to work were sedentary (41 days), light-medium (52 days) and heavy-very heavy (71 days).\u003c/p\u003e \u003cp\u003eSignificant physical activity at work prolongs return to work and duration of disability [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This influences spinal surgeons' choice of recovery recommendations to withstand workloads depending on the type of surgery and workplace requirements [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For non-fusion procedures, most surgeons recommended 2\u0026ndash;6 weeks off work before returning to a sedentary to light-moderate workload job and 7\u0026ndash;12 weeks off work for a heavy-very heavy workload job [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to compare TDR and MLD procedures on clinical outcomes and recovery time in Railway workers. In addition, in the specialized literature we have not encountered studies comparing the results of TDR and MLD procedures in patients with single-level LDH.\u003c/p\u003e \u003cp\u003eTDR and MLD procedures for single-level lumbar disk herniation had comparable number of surgical complications (p\u0026thinsp;=\u0026thinsp;0.47) and time to return to work (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The use of TDR compared favorably to MLD with improved last follow up ODI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), back pain (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), leg pain (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), SF-36 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as well as restoration of ROM (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), preservation of GLL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower rate of additional surgery procedures (p\u0026thinsp;=\u0026thinsp;0.04). 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 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThe main limitations of this study were: (1) single center nature of the study; (2) this study primarily composed of a unique, relatively homogeneous population of railway workers with risky strenuous labor responsibilities; (3) relatively short follow-up period of 1 year; (4) we did not analyze any other decompression and decompression-stabilization techniques; (5) we included only patients who were working before surgery since this was the only group for which we could obtain the workload information needed to stratify the 3 cohorts, our results may not be applicable to patients who were not working pre-operatively; (6) information on post-operative rehabilitation and overall post-operative management were not available so the effect of rehabilitation could not be included.\u003c/p\u003e \u003cp\u003eDespite these limitations, the strengths of the study include its 1-year follow-up on a large population of patients, recruited randomly, with a single diagnosis, treated by a single team without numerous confounding variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results showed that lumbar TDR and MLD are highly effective in improving clinical results 1 year follow-up in railway workers. However, the TDR technique has statistically significant advantages in terms of the dynamics of the level of leg pain, restoration of the functional state and quality of life compared to MLD at last follow up period. In addition, after lumbar TDR, there was a higher return to work rate in light-moderate and heavy-very heavy groups, which is most likely associated with restoration of segmental mobility, preservation of global lumbar lordosis and lower reoperations compared with MLD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical Approval\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Irkutsk State Medical University, protocol No.2, dated April 19, 2020.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach author made significant individual contributions to this manuscript. VAB (0000-0003-4349-7101)*, AAK (0000-0002-6059-4344)* and MAA (0000-0002-3190-2395)* were the main contributors to the drafting of the manuscript. VAB, AAK and YYP (0000-0001-7076-571X) performed the surgery, and patient follow-up, and gathered clinical data. AAK, MAA, YYP and RMY (0009-0002-7165-5373) evaluated the data from the statistical analysis. VAB, AAK, MAA, YYP and RMY performed the literature search and review of the manuscript, and contributed to the intellectual concept of the study. *ORCID (Open Researcher and Contributor ID).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding author (prof. Vadim A. Byvaltsev) for researchers who meet the criteria for access to confidential data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGBD 2016 DALYs and HALE Collaborators (2016) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10106):e38. https://doi.org/10.1016/S0140-6736(17)32130-X\u003c/li\u003e\n\u003cli\u003eJensen RK, Kongsted A, Kjaer P, Koes B (2019) Diagnosis and treatment of sciatica. BMJ 367:l6273. https://doi.org/10.1136/bmj.l6273\u003c/li\u003e\n\u003cli\u003eMehendiratta D, Patel P, Bhambhu V, Chaudhary K, Dalvie S (2022) Effect of Preoperative Parameters on Outcomes of Lumbar Microdiscectomy: A Retrospective Analysis. 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Chinese. https://doi.org/10.3760/cma.j.issn.1001-9391.2018.02.006\u003c/li\u003e\n\u003cli\u003eSingh S, McIntosh G, Dea N, Hall H, Paquet J, Abraham E, Bailey CS, Weber MH, Johnson MG, Nataraj A, Glennie RA, Attabib N, Kelly A, Rampersaud YR, Manson N, Phan P, Rachevitz M, Thomas K, Fisher C, Charest-Morin R (2022) Effects of Workload on Return to Work After Elective Lumbar Spine Surgery. Global Spine J 20:21925682221109558. https://doi.org/10.1177/21925682221109558\u003c/li\u003e\n\u003cli\u003eSchaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojaj\u0026auml;rvi A, Verbeek JH (2013) Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev 2013(8):CD001822. https://doi.org/10.1002/14651858.CD001822.pub3\u003c/li\u003e\n\u003cli\u003eRusso F, Papalia GF, Vadal\u0026agrave; G, Fontana L, Iavicoli S, Papalia R, Denaro V (2021) The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 18(23):12614. https://doi.org/10.3390/ijerph182312614\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"lumbar disk herniation, microsurgical lumbar discectomy, lumbar total disk replacement, return to work, workload intensity","lastPublishedDoi":"10.21203/rs.3.rs-3908015/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3908015/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective.\u003c/h2\u003e \u003cp\u003eTo 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).\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e \u003cp\u003eSeventy five patients, ages 25\u0026ndash;35 years, underwent single-level procedure and were randomly assigned to one of two groups: group I (n\u0026thinsp;=\u0026thinsp;37) had TDR and group II (n\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e \u003cp\u003eAs 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.\u003c/p\u003e\u003ch2\u003eConclusions.\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Clinical Effectiveness and Return to Work Rate After Lumbar Total Disk Replacement and Microsurgical Lumbar Discectomy in Railway Workers: a Prospective Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-01 16:15:44","doi":"10.21203/rs.3.rs-3908015/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af1ec5f1-aa09-4ddc-9381-04c2607ae350","owner":[],"postedDate":"February 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-10T21:14:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-01 16:15:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3908015","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3908015","identity":"rs-3908015","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}