title: Clinical outcomes of two revision strategies for failed total disc replacements.
abstract: OBJECTIVE
  To compare mid-term clinical outcomes of two revision strategies for patients with failed SB Charité III total disc replacements (TDRs).
  
  
  METHODS
  Eighteen patients with a failed TDR underwent posterolateral instrumented fusion (fusion group); in 21 patients, the TDR was removed and the intervertebral defect was filled with a bone strut graft, followed by an instrumented posterolateral fusion (removal group). Visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed.
  
  
  RESULTS
  Mean follow-up was 3.7 years (range 1.0-6.4) in the removal group and 4.4 years (range 0.7-11.0) in the fusion group. Although the removal group showed a significantly lower VAS and ODI score post-revision surgery as compared to preoperative (P < 0.01 and P = 0.01, respectively), no significant differences were found between the removal and fusion groups before and after revision surgery in VAS and ODI. A clinical relevant improvement in VAS and ODI was found in 47 and 21 % respectively in the removal group, and in 22 and 27 % respectively in the fusion group. Substantial complications were observed only in the removal group.
  
  
  CONCLUSIONS
  Both procedures showed improvement clinically. There were no significant additional benefits of removing the TDR as compared to fusion alone at mid-term follow-up. The clinical decision to remove the TDR should be carefully weighed up against potential risks and complications of this procedure.
authors.affiliation: Department of Orthopaedic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. i.punt@mumc.nl
authors.forename: Ilona
authors.initials: I
authors.lastname: Punt
authors.forename: Paul
authors.initials: P
authors.lastname: Willems
authors.forename: Steven
authors.initials: S
authors.lastname: Kurtz
authors.forename: Lodewijk
authors.initials: L
authors.lastname: van Rhijn
authors.forename: André
authors.initials: A
authors.lastname: van Ooij
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods*; D013123:Spinal Fusion; D059145:Total Disc Replacement / Q000009:adverse effects*; D017211:Treatment Failure