Abstract
PurposeTo compare the long-term clinical results and complications of two revision strategies for patients with failed total disc replacements (TDRs).MethodsIn 19 patients, the TDR was removed and the intervertebral defect was filled with a femoral head bone strut graft. In addition, instrumented posterolateral fusion was performed (removal group). In 36 patients, only a posterolateral instrumented fusion was performed (fusion group). Visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed.ResultsThe median follow-up was 12.3 years (range 5.3–24.3). In both the removal and fusion group, a similar (p = 0.515 and p = 0419, respectively) but significant decrease in VAS- (p = 0.001 and p = 0.001, respectively) and ODI-score (p = 0.033 and p = 0.013, respectively) at post-revision surgery compared to pre-revision surgery was seen. A clinically relevant improvement in VAS- and ODI-score was found in 62.5% and 43.8% in the removal group and in 43.5% and 39.1% in the fusion group (p = 0.242 and p = 0.773, respectively). Removal of the TDR was associated with substantial intra-operative complications such as major vessel bleeding and ureter lesion. The percentage of late reoperations for complications such as pseudarthrosis was comparable for both revision strategies.ConclusionsRevision of a failed TDR is clinically beneficial in about half of the patients. No clear benefits for additional TDR removal as compared to posterolateral instrumented fusion alone could be identified. Particularly, when considering the substantial risks and complications, great caution is warranted with removal of the TDR.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Fusion of a symptomatic lumbar spinal motion segment is still considered the gold standard for operative treatment of patients with degenerative disc disease (DDD) not1 3 Vol.:(0123456789)European Spine Journal (2020) 29:1527–1535 responding to conservative care [1,2,3]
Spinal fusion is associated with side effects such as cranial facet joint violations, decrease in sagittal motion, pseudarthrosis and symptomatic adjacent-level disease [4,5,6,7]
Total lumbar disc replacement (TDR) has been introduced to avoid those fusion-related side effects based on the hypothesis that chronic low back pain (CLBP) originates from DDD
Summary
Fusion of a symptomatic lumbar spinal motion segment is still considered the gold standard for operative treatment of patients with degenerative disc disease (DDD) not1 3 Vol.:(0123456789)European Spine Journal (2020) 29:1527–1535 responding to conservative care [1,2,3]. Fusion of a symptomatic lumbar spinal motion segment is still considered the gold standard for operative treatment of patients with degenerative disc disease (DDD) not. Spinal fusion is associated with side effects such as cranial facet joint violations, decrease in sagittal motion, pseudarthrosis and symptomatic adjacent-level disease [4,5,6,7]. Total lumbar disc replacement (TDR) has been introduced to avoid those fusion-related side effects based on the hypothesis that chronic low back pain (CLBP) originates from DDD. TDR has been associated with drawbacks, such as subsidence, luxation or malposition of the implant, increasing axial rotational instability and excessive loads to the facet joints [8,9,10]. Several studies with midto long-term results reported that 6–14% of the patients had revision fusion surgery after TDR [11,12,13,14,15,16,17]
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