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


October 2019, pp 1 - 8 Original Article Read Full Article 10.1007/s00586-019-06184-x

First Online: 29 October 2019

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

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.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]


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