A Granulomatous Mass Surrounding a Maverick Total Disc Replacement Causing Iliac Vein Occlusion and Spinal Stenosis

Abstract

Lumbar disc degeneration is a well-known cause of low back pain. The so-called gold standard for definitive operative treatment of discogenic pain is interbody arthrodesis1. Adjacent-level degeneration as well as incomplete pain resolution despite radiographic evidence of fusion has led to dissatisfaction with this technique and became the impetus to develop other surgical options for the treatment of back pain2-5. With the U.S. Food and Drug Administration approval of the CHARITE Total Disc (DePuy Spine, Raynham, Massachusetts) in 2004, total disc replacement became a treatment option for the painful degenerative lumbar disc in the United States. Proponents of this procedure believe that the maintenance of disc height and the preservation of segment motion will facilitate the resumption of more normal activities, decrease pain, and prevent adjacent-segment disease. Unlike the metal-on-ultra-high-molecular-weight-polyethylene sliding core design of the CHARITE total disc, the Maverick total disc replacement (Medtronic Sofamor Danek, Memphis, Tennessee) is a metal-on-metal disc prosthesis made of cobalt-chromium with a ball-and-socket design. The center of rotation of the Maverick prosthesis is fixed posteriorly in comparison with the dynamic center of rotation of the CHARITE prosthesis. The metal end plates are coated with hydroxyapatite and have a central keel for increased stability and fixation2. We present the case of a patient who had development of a granulomatous mass at the level of a Maverick total disc prosthesis three years following implantation that resulted in symptomatic spinal stenosis and iliac vein occlusion with resultant deep venous thrombosis. The patient was informed that data concerning the case would be submitted for publication, and she consented. A thirty-five-year-old woman presented to the emergency department with the acute onset of bilateral lower extremity edema and severe lower extremity pain. The patient had a one-year history of bilateral lower extremity …