title: Novel indication for posterior dynamic stabilization: Correction of disc tilt after lumbar total disc replacement.
abstract: BACKGROUND
  The increase in total disc replacement procedures performed over the last 5 years has increased the occurrence of patients presenting with postoperative iatrogenic deformity requiring revision surgery. Proposed salvage treatments include device retrieval followed by anterior lumbar interbody fusion or posterior fusion. We propose a novel approach for the correction of disc tilt after total disc replacement using a posterior dynamic stabilization system.
  
  
  METHODS
  Pedicle screws can be inserted either in an open manner or percutaneously by standard techniques under fluoroscopy. The collapsed side is expanded, and the convex side is compressed. Universal spacers are placed bilaterally, with the spacer on the collapsed side being taller by 6 mm. Cords are threaded through the spacers and pulled into place with the tensioning instrument. Extra tension is applied to the convex side, and the wound is closed by standard techniques.
  
  
  RESULTS
  Three patients presenting with tilted total disc replacement devices underwent corrective surgery with posterior dynamic stabilization. Radiographs confirmed correction of deformity in all cases.
  
  
  CONCLUSIONS
  This technical note presents a novel indication for posterior dynamic stabilization and describes its surgical application to the correction of disc tilt after total disc replacement. This is level V evidence.
authors: Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA.
authors: Wayne K
authors: WK
authors: Cheng
authors: Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA.
authors: Daniel Kyle
authors: DK
authors: Palmer
authors: Department of Neurology, University of Minnesota, Minneapolis, MN.
authors: Vikram
authors: V
authors: Jadhav