Leary Scott P, Regan John J, Lanman Todd H, Wagner Willis H
Spine Center at Century City Doctors Hospital, Los Angeles, CA, USA.
Spine (Phila Pa 1976). 2007 Apr 20;32(9):1001-11. doi: 10.1097/01.brs.0000260794.73938.93.
A large case series of anterior revision surgery in patients who had complications following lumbar total disc replacement with the CHARITE artificial disc.
To analyze and discuss the etiology of implant-related complications and to present a strategy that can be applied to lumbar intervertebral disc prostheses in cases where anterior revision surgery is necessary.
This report represents the largest single-site, consecutive case series reported in the literature of anterior revision surgery following lumbar disc arthroplasty.
A total of 18 patients are included in this study. All patients required an anterior revision procedure for repositioning or removal of the prosthesis. The mean time to revision was 6 months (range, 9 days to 4 years).
In 17 of 20 cases, implant removal was required and the patient was converted to a fusion. In 3 cases, primary revision of the CHARITE artificial disc was performed. Six revision cases were performed within the early postoperative period, defined as 7 to 14 days. All early cases were approached via reexploration of the original anterior midline retroperitoneal incision. Late revision was required in 14 cases, ranging from 3 weeks to 4 years following initial arthroplasty. A variety of surgical approaches were used in late revisions, including the lateral transpsoas approach at L3-L4 or L4-L5 (n = 5), expanded ipsilateral left retroperitoneal approach at L4-L5 (n = 2), contralateral right retroperitoneal approach at L5-S1 (n = 6), and transperitoneal approach (n = 1). Following 20 consecutive, anterior revision procedures, implant revision was successfully achieved in all cases.
Total disc replacement implant revisions occur largely as a result of technical errors in positioning and sizing of the implant. In addition, adherence to strict patient selection criteria will eliminate many cases of implant failure. When necessary, anterior revision surgery can be performed safely when a strategic approach is used.
一项关于接受CHARITE人工椎间盘腰椎全椎间盘置换术后出现并发症患者的前路翻修手术的大型病例系列研究。
分析并讨论植入物相关并发症的病因，并提出一种在前路翻修手术必要时可应用于腰椎间盘假体的策略。
本报告是腰椎间盘置换术后前路翻修手术文献中报道的最大规模的单中心连续病例系列。
本研究共纳入18例患者。所有患者均需要进行前路翻修手术以重新放置或取出假体。翻修的平均时间为6个月（范围为9天至4年）。
20例中有17例需要取出植入物并转为融合手术。3例进行了CHARITE人工椎间盘的初次翻修。6例翻修手术在术后早期进行，定义为术后7至14天。所有早期病例均通过重新探查原前正中腹膜后切口进行处理。14例需要进行晚期翻修，时间为初次置换术后3周 至4年。晚期翻修采用了多种手术入路，包括L3-L4或L4-L5节段的经腰大肌外侧入路（n = 5）、L4-L5节段的扩大同侧左腹膜后入路（n = 2）、L5-S1节段的对侧右腹膜后入路（n = 6）以及经腹入路（n = 1）。经过连续20例前路翻修手术后，所有病例均成功完成了植入物翻修。
全椎间盘置换植入物翻修主要是由于植入物定位和尺寸的技术错误导致的。此外，严格遵守患者选择标准可消除许多植入物失败的病例。必要时，采用策略性方法可安全地进行前路翻修手术。
