Long-term clinical outcome of two revision strategies for failed total disc replacements

J Kitzen*, T F G Vercoulen, S M J van Kuijk, M G M Schotanus, N P Kort, L W van Rhijn, P C P H Willems

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Web of Science)

Abstract

PURPOSE: To compare the long-term clinical results and complications of two revision strategies for patients with failed total disc replacements (TDRs).

METHODS: In 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.

RESULTS: The median follow-up was 12.3 years (range 5.3-24.3). In both the removal and fusion groups, 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 re-operations for complications such as pseudarthrosis were comparable for both revision strategies.

CONCLUSIONS: Revision 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. In particular, when considering the substantial risks and complications, great caution is warranted with removal of the TDR. These slides can be retrieved under Electronic Supplementary Material.

Original languageEnglish
Pages (from-to)1536-1543
Number of pages8
JournalEuropean Spine Journal
Volume29
Issue number7
Early online date29 Oct 2019
DOIs
Publication statusPublished - Jul 2020

Keywords

  • Degenerative disc disease
  • Lumbar spine
  • Fusion
  • Spine arthroplasty
  • Risk factors
  • INVESTIGATIONAL-DEVICE-EXEMPTION
  • DEBRIS INDUCES INFLAMMATION
  • CHARITE ARTIFICIAL DISC
  • 5-YEAR FOLLOW-UP
  • LUMBAR FUSION
  • CIRCUMFERENTIAL FUSION
  • ADJACENT
  • VASCULARIZATION
  • COMPLICATIONS
  • DEGENERATION

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