Department of Orthopedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Orthopedic Surgery, Zuyderland Medical Centre, P.O. Box 500, 6130 MB, Sittard-Geleen, The Netherlands.
Eur Spine J. 2020 Jul;29(7):1527-1535. doi: 10.1007/s00586-020-06308-8. Epub 2020 Jan 29.
To compare the long-term clinical results and complications of two revision strategies for patients with failed total disc replacements (TDRs).
In 19 patients, the TDR was removed and the intervertebral defect was filled with a femoral head bone strut graft. In addition, instrumented posterolateral fusion was performed (removal group). In 36 patients, only a posterolateral instrumented fusion was performed (fusion 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.
The median follow-up was 12.3 years (range 5.3-24.3). In both the removal and fusion group, a similar (p = 0.515 and p = 0419, respectively) but significant decrease in VAS- (p = 0.001 and p = 0.001, respectively) and ODI-score (p = 0.033 and p = 0.013, respectively) at post-revision surgery compared to pre-revision surgery was seen. A clinically relevant improvement in VAS- and ODI-score was found in 62.5% and 43.8% in the removal group and in 43.5% and 39.1% in the fusion group (p = 0.242 and p = 0.773, respectively). Removal of the TDR was associated with substantial intra-operative complications such as major vessel bleeding and ureter lesion. The percentage of late reoperations for complications such as pseudarthrosis was comparable for both revision strategies.
Revision of a failed TDR is clinically beneficial in about half of the patients. No clear benefits for additional TDR removal as compared to posterolateral instrumented fusion alone could be identified. Particularly, when considering the substantial risks and complications, great caution is warranted with removal of the TDR. These slides can be retrieved under Electronic Supplementary Material.
比较两种翻修策略治疗全椎间盘置换失败患者的长期临床结果和并发症。
在 19 例患者中，去除 TDR 并在椎间隙缺损处填充股骨头骨支柱移植物。此外，还进行了器械后路融合（去除组）。在 36 例患者中，仅进行后路器械融合（融合组）。术前和术后均完成视觉模拟评分（VAS）疼痛和 Oswestry 功能障碍指数（ODI）。评估两种翻修策略的术中及术后并发症。
中位随访时间为 12.3 年（范围 5.3-24.3）。在去除组和融合组中，VAS（p=0.515 和 p=0.419）和 ODI 评分（p=0.001 和 p=0.001）均显著降低，与术前相比术后（p=0.001 和 p=0.001）。在去除组和融合组中，VAS 和 ODI 评分分别有 62.5%和 43.8%（p=0.242）和 43.5%和 39.1%（p=0.773）的患者获得了临床相关的改善。去除 TDR 与术中大出血和输尿管损伤等严重并发症有关。两种翻修策略的并发症如假关节形成的晚期再手术率相当。
翻修失败的 TDR 在大约一半的患者中具有临床益处。与单独后路器械融合相比，去除 TDR 并不能明确带来更多益处。特别是，考虑到潜在的风险和并发症，去除 TDR 时需要格外谨慎。这些幻灯片可在电子补充材料中获取。
