Revision and explantation strategies involving the CHARITE lumbar artificial disc replacement.
METHODS
A large case series of anterior revision surgery in patients who had complications following lumbar total disc replacement with the CHARITE artificial disc.


OBJECTIVE
To analyze and discuss the etiology of implant-related complications and to present a strategy that can be applied to lumbar intervertebral disc prostheses in cases where anterior revision surgery is necessary.


BACKGROUND
This report represents the largest single-site, consecutive case series reported in the literature of anterior revision surgery following lumbar disc arthroplasty.


METHODS
A total of 18 patients are included in this study. All patients required an anterior revision procedure for repositioning or removal of the prosthesis. The mean time to revision was 6 months (range, 9 days to 4 years).


RESULTS
In 17 of 20 cases, implant removal was required and the patient was converted to a fusion. In 3 cases, primary revision of the CHARITE artificial disc was performed. Six revision cases were performed within the early postoperative period, defined as 7 to 14 days. All early cases were approached via reexploration of the original anterior midline retroperitoneal incision. Late revision was required in 14 cases, ranging from 3 weeks to 4 years following initial arthroplasty. A variety of surgical approaches were used in late revisions, including the lateral transpsoas approach at L3-L4 or L4-L5 (n = 5), expanded ipsilateral left retroperitoneal approach at L4-L5 (n = 2), contralateral right retroperitoneal approach at L5-S1 (n = 6), and transperitoneal approach (n = 1). Following 20 consecutive, anterior revision procedures, implant revision was successfully achieved in all cases.


CONCLUSIONS
Total disc replacement implant revisions occur largely as a result of technical errors in positioning and sizing of the implant. In addition, adherence to strict patient selection criteria will eliminate many cases of implant failure. When necessary, anterior revision surgery can be performed safely when a strategic approach is used.
Leary
Scott P
SP
Spine Center at Century City Doctors Hospital, Los Angeles, CA, USA.
Regan
John J
JJ
Lanman
Todd H
TH
Wagner
Willis H
WH
D000328:Adult; D000368:Aged; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants / Q000009:adverse effects*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure