Robinson Yohan, Sandén Bengt
Uppsala University Hospital, Institute for Surgical Sciences, Department of Orthopaedics, Uppsala, Sweden.
Patient Saf Surg. 2009 Jul 20;3(1):15. doi: 10.1186/1754-9493-3-15.
Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures.
Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures.
Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI.
Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.
大多数腰椎人工椎间盘仍由不锈钢合金制成，这使得在使用磁共振成像（MRI）时无法对手术区域进行充分的术后诊断成像。因此，植入不锈钢假体后出现术后神经根症状或间歇性跛行的患者通常需要其他诊断程序。
从现有文献中回顾腰椎全椎间盘置换术（TDR）可能的并发症，并针对植入物类型给出影像学建议。文中给出了两个说明性病例。
与手术入路相关的并发症、感染、植入物磨损、松动或骨折、聚乙烯衬垫移位、小关节肥大、中央管狭窄以及手术节段的强直在钛合金和不锈钢植入物中均可见，但由于MRI中的磁伪影，需要不同的成像方式。
在评估TDR术后患者时应考虑采用其他放射学检查方法。腰椎TDR术后的并发症，包括导致神经根病的椎管狭窄和植入物松动，可以通过脊髓造影和放射性核素技术进行可视化，作为平片X线摄影的辅助手段。即使存在大量不锈钢TDR植入物，如果应用脊髓造影和放射性核素技术，腰椎神经根狭窄和植入物松动也可以被可视化。
