Abstract

Study Design. Case report. Objective. To identify a safe technique for salvage surgery following complications of total disc replacement. Summary of Background Data. Lumbar total disc replacement (TDR) is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation. Methods and Results. A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor. Conclusion. The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf.

Highlights

  • Lumbar disc replacement is becoming a popular surgical choice in the management of discogenic back pain

  • The indications for total disc replacement (TDR) remain specific and the procedure should only be done in valid cases of discogenic back pain in selected patients

  • The problematic TDR had the potential to compromise the fixation of the fracture with an associated spondylolisthesis

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Summary

Introduction

Lumbar disc replacement is becoming a popular surgical choice in the management of discogenic back pain. In the last decade there have been a handful of unfortunate cases of anterior dislocation of the polyethylene inlay of Charite III and ProDisc-L (Synthes, USA) prostheses [1]. These cases have been identified as unusual and unforeseen complications. Longterm complications of TDR and the subsequent management strategies are not well described This case demonstrates the success of using a percutaneous lumbar fixation system (PERPOS-PLS) from Interventional Spine (Irvine, CA, USA) to salvage a significant complication following TDR. The relative benefits of the technique and use of the system are described in this paper

Case History
Operative Management
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