[Findings in 67 patients with recurrent or persistent symptoms after implantation of a disc prosthesis for low back pain].
OBJECTIVE
To determine the symptoms in patients who presented with persistent or recurrent backache or leg pain after implantation of an artificial disc prosthesis.


METHODS
Descriptive.


METHODS
During the past II years in the Maastricht University Hospital (n=65) and the Utrecht University Medical Centre (n=2), 67 patients were seen with persistent or recurrent backache or leg pain in whom, an average of 53 months previously, one or more SB Charité-III lumbar-disc prostheses had been implanted elsewhere. The results were evaluated.


RESULTS
The most prominent findings were: migration of the prosthesis (n=6); subsidence into the vertebra (n=35); disc degeneration at one or more neighbouring levels (n=34) and arthrosis of facet joints (n=24). In 9 cases, rupture of the metal wire around the polyethylene core was observed and in 5 cases there were radiological signs of polyethylene wear. Re-operation (spondylodesis) was generally unsatisfactory if the prosthesis was left in place. In 21 patients, the prosthesis was removed; all specimens showed polyethylene wear or rupture.


CONCLUSIONS
Published results are mostly case series and suffer from observer bias; moreover, the benefits are moderate. Given the uncertain role ofdisc degeneration in patients with chronic backache, the real risk of complications and the uncertain advantages, the implantation ofa disc prosthesis is difficult to defend.
van Ooij
A
A
Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ Maastricht. avoo@sort.azm.nl
Schurink
G W H
GW
Oner
F C
FC
Verbout
A J
AJ
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D001416:Back Pain / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D007866:Leg; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation