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xx Complications and surgical revision for failed dis
« Thread started on: Jan 24th, 2013, 09:08am »


Complications and surgical revision for failed disc arthroplasty
John P. Kostuik,
Volume 4, Issue 6 (Supplement), Pages S289-S291 (November 2004)
Kostuik JP. Complications and surgical revision for failed disc arthroplasty. Spine 2004;4:289 – 91.

If disc arthroplasty fails, there are three options: posterior fusion; revision replacement; and, anterior fusion

On revision surgery, Santos, et al., state, “Revision surgery for a failed disc arthroplasty is life threatening. Dealing with the scarring around the great vessels is the main challenge. Indeed, the location of vital vascular structures may make it altogether impossible to perform such anterior abdominal exposures.”

Inaccurate implant positioning often causes complications in TDR surgery
Hallet H. Matthews, MD (here)

Possible ADR after failed fusion
Life threatening surgery to revise ADR? (adrSupport)

Total disc replacement in the lumbar spine: a systematic review of the literature

Revisability of the CHARITE artificial disc replacement:
McAfee PC, Geisler FH, Saiedy SS, Moore SV, Regan JJ, Guyer RD, Blumenthal SL, Fedder IL, Tortolani PJ, Cunningham B. Related Articles, Links
Spine. 2006 May 15;31(11):1217-26.
Analysis of 688 Patients Enrolled in the U.S. IDE Study of the CHARITE Artificial Disc.
52/589 TDR (8.8%) required reoperation,... There were 24 TDR patients who underwent a repeated anterior retroperitoneal approach, with 22/24 (91.7%) having had a successful removal of the prosthesis.

Revisability of the Charite' artificial disc replacement:
analysis of 347 patients enrolled in the US IDE Study of the Charite' artificial disc.
McAfee PC, Geisler F, Saiedy S, et al.
5th Annual Global Symposium Spine Arthroplasty Society. New York, 2005.

Roundtables in Spine Surgery: Complications and revision strategies in lumbar spine arthroplasty.
McAfee PC, Geisler FH, Scott-Young M eds.
St. Louis: Quality Medical Publishing, 2005. (roundtable discussion and monograph through a restricted educational grant by DePuy Spine).
Volume 1, Number 2 (2005): pp. 133–213.
Currently, the major deficiency in the rules and experimental design of the cervical and lumbar prospective randomized trials is that they do not differentiate between prostheses that are difficult or easy to revise.

Total Disc Replacement Complications and Strategies for Revision
James Zucherman, Zuchermanj@aol.com St. Mary's Spine Center #450
San Francisco, CA 94117

Proper sagittal alignment allows for the devices to function as they are intended with maximum motion. This also reduces the forces on the implant and on the posterior elements. As mentioned above, adequate posterior vertebral height is mandatory, and unless the disc height is unusually high, typically the entire posterior annulus is loosened or transected, as well as the PLL.

Complications of lumbar artificial disc replacement vs. fusion:
results from the randomized, multicenter FDA IDE Study of the Charite' artificial disc.
Holt R, Majd ME, Isaza JE, et al.
5th Annual Global Symposium Spine Arthroplasty Society. New York, 005.

Revision Anterior Spinal Surgery: Strategies and Complications
G.A. Fantini, F.P. Girardi, F.P. Cammisa, Jr.

Cervical and Lumbar Disc Replacement—The Ease of Revision
McAfee P C, Geisler F H, Scott-Young M,

Complications and strategies for revision surgery in total disc replacement.
Rudolf Bertagnoli
Bertagnoli R, Zigler J, Karg A, Voigt S.
Orthop Clin North Am. 2005 Jul;36(3):389-95. http://b.lib.bioinfo.pl/pmid:15950699
Revision strategies for failed total disc arthroplasty can be planned as a posterior fusion, leaving the total disc replacement device in place, or by way of anterior removal with subsequent anterior fusion or revision replacement of the prosthesis.

Insertion of an antiadhesive membrane
Another strategy to make vascular dissection easier and safer is to use an anti-adhesive membrane (eg, Gore-Tex, W. L. Gore & Associates, Inc., Newark, Delaware). This membrane is inserted between the prosthesis and the great vessels during the primary surgery. In a revision surgery, the vessels can more easily be dissected from the anterior spine and mobilized to the right side Another way to reduce adhesions between the great vessels and the spine is to keep manipulation of the vessels to a minimum with gentle surgical technique, thus minimizing fibrosis between the vessels and the spine.

When the decision is made to explant the device and fuse the segment, the revision intervention should ideally be performed from an oblique or lateral approach to avoid significant manipulation of the great vessels, which is especially critical in the L4-5 area. By performing oblique or lateral partial corpectomy, even prostheses with a fixation keel can be removed without significant vascular manipulation.

Explantation of ProDisc with subsequent anterior fusion (complication occurred due to trauma) A 39-year-old woman had been treated with implantation of a ProDisc prosthesis at the L5-S1 level. Three months after surgery, the patient fell on her buttocks, causing an impaction fracture of the upper end plate of the prostheses into the L5 vertebral body (Fig. 4A, B). Conservative treatment for 3 more months could not reduce the level of her persistent increased low back pain. Six months after implantation, revision surgery with implant removal and anterior cage and (pyramid?) plate fixation was performed (Fig. 4C, D). After this surgery, her low back pain was completely resolved.

SPINAL ARTHROPLASTY WITH DVD, The Preservation of Motion
http://www.us.elsevierhealth.com/product.jsp?isbn=9781416031253 $199.00,
Alexander Vaccaro, MD, Professor of Orthopaedic Surgery, Thomas Jefferson University Hospital, The Rothman Institute, Philadelphia, PA
Stephen Papadopoulos, MD, Barrow Neurology Associates, LTD, Phoenix, AZ
Vincent Traynelis, MD, Professor of Neurology, University of Iowa Hospital, Iowa City, IA
Regis Haid, MD, Atlanta Brain & Spine Care, Atlanta, GA
Rick Sasso, MD, Indiana Spine Group, Indianapolis, IN

The Importance of New Strategies for Revision and Retrieval Lumbar Total Disc Replacement: Beyond the Traditional Approach - Prospective 4 Years Follow-Up Study.
The Spine Journal, Volume 6, Issue 5, Pages 142S-142S
L. Pimenta, R. Diaz, L. Guerrero

Book Chapter: Revision Strategies for Failed Lumbar Arthroplasty
Peloza, J.
In: Spinal Arthroplasty
Editor: Alexander Vaccaro, M.D.
Elsevier Publication, 2006.




Failure of bone healing of the fusion (“pseudo-arthrosis”) can occur in 5 to 40% of cases, depending on the specific surgical technique used and the patient’s individual risk factors. If metallic implants were used and the fusion does not heal, this will eventually result in loosening or breakage of the screws or rods, as they are not meant to be relied upon to stabilize the spine indefinitely.
[Thus, you can not leave the device in, as it will provide zero stability to the posterior instrumentation.]

Lumbosacral Fusion: Cages, Dowels and Pedicle Screws
Rick C. Sasso, M.D.
The recent interest in performing lumbar interbody arthrodesis with use of cages is attributable to three factors according to McAfee. 64 First, the rate of failure associated with use of bone graft alone is high. Second, the rate of failure associated with use of posterior pedicle-screw instrumentation is high. And finally, the rate of success associated with use of stand-alone anterior fusion cages and autogenous bone graft is high. This obviates the need to perform a 360 (combined anterior and posterior) lumbar arthrodesis with use of posterior instrumentation. Interbody fusion cages have had a tremendous effect on anterior fusion. The rates of fusion after anterior interbody arthrodesis have improved from Stauffer and Coventry's90 56% to 93% with the use of the BAK titanium cage.60



PEEK Becoming an Alternative to Titanium in Spinal Fusion Cages

Infuse® Bone Graft
INFUSE® Bone Graft represents an rhBMP-2 (recombinant human bone morphogenetic protein- 2) formulation combined with a bovine-derived absorbable collagen sponge (ACS) carrier.

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