Traumatic burst fracture in a patient with a lumbar artificial disc.
Lumbar disc arthroplasty is now a common treatment for lumbar degenerative disc disease. Whereas the immediate and delayed complications in patients with artificial lumbar discs are well reported, the durability of artificial disc hardware after severe spine trauma is unknown. The authors describe the management of a rare case of a traumatic lumbar burst fracture in a patient who had undergone disc arthroplasty. This 31-year-old male contractor had undergone placement of an L4-5 Charité artificial disc (DePuy Spine) and L5-S1 anterior lumbar fusion 10 months before he fell from a roof and sustained a traumatic L-3 burst fracture with significant canal compromise and cauda equina injury. Despite the considerable compressive load on his spine, the artificial disc (L4-5) remained intact without any radiological signs of hardware failure, and the vertebrae above (L-4) and below (L-5) the artificial disc had no signs of injury. For the L-3 burst fracture the patient underwent an open decompressive laminectomy at L2-3 and posterior fusion with instrumentation from L-2 to L-4. At 24 months postinjury, he had returned to full work activities as a contractor with minimal back pain and mild right lower-extremity sensory changes and weakness left over from the trauma. The total disc arthroplasty at L4-5 is functional and has preserved motion, and there is a solid fusion at L2-4 and L5-S1. This case demonstrates that a lumbar artificial disc can tolerate a significant load from trauma and remain functional without hardware failure even after a traumatic burst fracture at the adjacent lumbar vertebral body and shows the successful treatment of this fracture, with posterior fusion preserving the motion of an artificial disc.
Gottfried
Oren N
ON
Department of Orthopaedics, University of Utah, Salt Lake City, Utah 84108, USA.
Brodke
Darrel S
DS
D000328:Adult; D001178:Arthroplasty; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D007403:Intervertebral Disc; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D019736:Prostheses and Implants; D012447:Sacrum; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion