title: Infection and revision strategies in total disc arthroplasty.
abstract: OBJECTIVE
  Our aim was to revise the different strategies for treating an infected disc arthroplasty.
  
  
  METHODS
  Despite recognition that disc replacement may reduce the incidence of adjacent-segment disease, the risk of potential complications associated with primary and revision total disc arthroplasty has diminished surgeon enthusiasm for the procedure. We performed a literature review of the different revision strategies for an infected disc arthroplasty.
  
  
  RESULTS
  The need for revision of lumbar total disc arthroplasty has been reported in a number of prospective, randomised trials (level I or II evidence). Suboptimal patient selection and/or surgical technique accounted for the majority of failed disc arthroplasties. Revision procedures include posterior stabilisation or anterior extraction and conversion to arthrodesis. The risk of injury to the great vessels and retroperitoneal structures is greater during revision than primary procedures. The use of a distant lateral, or transpsoas, approach to the anterior column may reduce these adverse events. Also, the use of adhesion barriers has been shown to reduce adhesions in abdominal and pelvic surgery and may be of benefit in revision disc arthroplasty.
  
  
  CONCLUSIONS
  This review article provides an update on the various treatments for infected lumbar disc prosthesis and the different surgical approaches used in these difficult cases. It also describes potential options to avoid complications associated with the revision surgical approach.
authors.affiliation: Lenox Hill Hospital, New York, NY 10075, USA. agerometta@wanadoo.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Gerometta
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Rodriguez Olaverri
authors.forename: Fabian
authors.initials: F
authors.lastname: Bittan
mesh_terms: D003646:Debridement; D004322:Drainage; D006801:Humans; D008159:Lumbar Vertebrae; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D012086:Reoperation; D007507:Therapeutic Irrigation; D059145:Total Disc Replacement / Q000009:adverse effects*