Department of Orthopaedics and Rehabilitation, Oregon Health Sciences University, Portland, OR 97229, USA.
Spine (Phila Pa 1976). 2010 Jan 1;35(1):44-50. doi: 10.1097/BRS.0b013e3181b9d556.
Case series of 2-level lumbar disc arthroplasties treated by the authors.
Identify a potentially significant failure rate of 2-level disc arthroplasty due to coronal plane instability.
Arthrodesis remains the standard for surgical treatment of degenerative disc disease, despite concerns about adjacent level degeneration and persistent postoperative pain in some patients. Total disc arthroplasty has been proposed as a way to reduce these problems. Intermediate follow-up of 1-level procedures demonstrates promising safety and improved pain scores. Some surgeons are expanding the surgical indications to more challenging settings, including multilevel disease.
We report here our experience with 4 cases of failed 2-level disc arthroplasty.
We have seen 4 patients with failed 2-level lumbar arthroplasty, of those 2 performed in Germany and 2 performed in our state by 2 different experienced spine surgeons. The 2 local cases represent 29% (2/7) of all 2-level CHARITE arthroplasties performed within our state. All 4 patients presented within 11 to 13 months of implantation with increased back pain and radicular symptoms. The mechanism of failure was coronal instability due to small deviations of the prostheses from a midline position in all 4 cases.
Disc arthroplasty appears to be a safe and effective treatment for 1-level lumbar degenerative disc disease. Although promising biomechanical reports of 2-level models are emerging, we are concerned by the rate of failures of 2-level arthroplasty that we are seeing. It appears that the potential for coronal plane instability increases as the number of levels increases. Given the costs and risks associated with these procedures, we feel that this issue deserves the attention of the spine surgery community despite the limited numbers in this report.
作者进行的 2 级腰椎间盘置换术病例系列研究。
确定 2 级椎间盘置换术因冠状面不稳定而导致的潜在高失败率。
尽管一些患者存在相邻节段退变和持续术后疼痛的担忧，融合术仍然是退行性椎间盘疾病的标准手术治疗方法。全椎间盘置换术被提出作为减少这些问题的一种方法。1 级手术的中期随访结果表明其具有较好的安全性和疼痛评分改善。一些外科医生正在将手术适应证扩展到更具挑战性的环境，包括多节段疾病。
我们在此报告 4 例 2 级椎间盘置换术失败的经验。
我们观察到 4 例 2 级腰椎置换术失败的患者，其中 2 例在德国进行，2 例在我们所在州由 2 位经验丰富的脊柱外科医生进行。在我们所在州进行的所有 2 级 CHARITE 置换术中有 29%（2/7）为本地病例。所有 4 例患者均在植入后 11 至 13 个月出现腰痛和神经根症状加重。所有 4 例患者的假体均因偏离中线而导致冠状面不稳定，假体在 4 例患者中均出现小偏差。
椎间盘置换术似乎是治疗 1 级腰椎退行性椎间盘疾病的一种安全有效的方法。尽管出现了有前景的 2 级模型生物力学报告，但我们对我们所见的 2 级置换术失败率感到担忧。随着节段数的增加，冠状面不稳定的可能性似乎增加。考虑到这些手术的成本和风险，我们认为尽管本报告中的病例数量有限，但这个问题值得脊柱外科医生关注。
