Revision of a lumbar disc arthroplasty following late infection.
Anterior removal of a lumbar total disc replacement implant is often a very technically demanding procedure. The anterior retroperitoneal anatomy is prone to scarring, limiting remobilization and making a direct anterior exposure above the L5-S1 level difficult if not impossible to achieve safely. Anterolateral approach strategies can be more safely achieved at L4-L5 and above, but may require vertebral osteotomy in order to remove a keeled prosthesis. Successful conversion to a fusion with implant removal can be achieved, even when osteotomy is needed for implant removal. This Grand Rounds case presentation involves an unusual late retroperitoneal abscess following two-level TDR with direct extension to one of the implants, and the subsequent nonoperative and operative management. Removal of a well-fixed keeled implant at the L4-L5 level following nonoperative treatment of a surrounding retroperitoneal abscess and conversion to fusion represents close to, if not a 'worst-case' scenario for revision TDR. However, with proper preoperative planning and surgical experience, a safe and successful procedure can be the end result.
Spivak
Jeffrey M
JM
NYU Hospital for Joint Diseases Spine Center, 301 East 17th Street, New York, NY 10003, USA. jeffrey.spivak@nyumc.org
Petrizzo
Anthony M
AM
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000328:Adult; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D004185:Disability Evaluation; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000601:surgery; D017116:Low Back Pain / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011859:Radiography; D012086:Reoperation; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging; D013123:Spinal Fusion; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome