Department of Spine Surgery, University Hospital of Strasbourg, Strasbourg, France.
Clin Spine Surg. 2021 Jul 1;34(6):E315-E322. doi: 10.1097/BSD.0000000000001179.
This was a retrospective clinical review.
The objective of this study was to analyze failure mechanisms after total lumbar disk replacement (TDR) and surgical revision strategies in patients with recurrent low back pain (LBP).
Several reports indicate that TDR revision surgery carries a major risk and that it should not be recommended. The clinical results of posterior instrumented fusion using the prosthesis like an interbody cage have not been well analyzed.
From 2003 to 2018, 48 patients with recurrent LBP after TDR underwent revision surgery. The average age was 39 years (24-61 y). The mean follow-up was 100.4 months (24.6-207.7 mo). Clinical data, self-assessment of patient satisfaction, and Oswestry Disability Index collected at each clinical control or by phone call for the older files and radiologic assessments were reviewed. The surgical revision strategy included posterior fusion in 41 patients (group A) and TDR removal and anterior fusion in 7 patients (group B), of which 6 patients had an additional posterior fixation.
Facet joint osteoarthritis was associated with TDR failure in 85%. In 68% the position of the prosthesis was suboptimal. Range of motion was preserved in 25%, limited in extension in 65%, and limited in flexion in 40%. Limited range of motion and facet joint osteoarthritis were significantly related (P=0.0008). The complication rate in group B was 43% including iliac vein laceration. Preoperative and 2-year follow-up Oswestry Disability Index were 25.5 and 22.0, respectively, in group A versus 27.9 and 21.3 in group B.
Posterior osteoarthritis was the principal cause of recurrent LBP in failed TDR. The anterior approach for revision carried a major vascular risk, whereas a simple posterior instrumented fusion leads to the same clinical results.
Level IV.
这是一项回顾性临床研究。
本研究的目的是分析全腰椎间盘置换（TDR）后失败的机制，并探讨复发性腰痛（LBP）患者的手术翻修策略。
有几份报告表明，TDR 翻修手术风险较大，不应推荐使用。使用假体（如椎间融合器）进行后路器械固定融合的临床效果尚未得到很好的分析。
2003 年至 2018 年，48 例 TDR 后复发性 LBP 患者接受了翻修手术。平均年龄为 39 岁（24-61 岁）。平均随访时间为 100.4 个月（24.6-207.7 个月）。对每位患者的临床数据、自我评估的患者满意度以及 Oswestry 功能障碍指数（ODI）进行了评估，这些数据是通过每次临床随访或对较老的病历进行电话随访收集的，同时还进行了影像学评估。手术翻修策略包括后路融合 41 例（A 组）和 TDR 取出及前路融合 7 例（B 组），其中 6 例患者还进行了额外的后路固定。
关节突关节骨关节炎与 TDR 失败有关，占 85%。68%的假体位置不理想。25%的患者活动度保持不变，65%的患者活动度在伸展时受限，40%的患者在屈曲时受限。活动度受限和关节突关节骨关节炎有显著相关性（P=0.0008）。B 组的并发症发生率为 43%，包括髂静脉撕裂。A 组的术前和 2 年随访 ODI 分别为 25.5 和 22.0，B 组分别为 27.9 和 21.3。
后路骨关节炎是 TDR 失败后复发性 LBP 的主要原因。前路翻修的主要血管风险，而单纯后路器械固定融合可获得相同的临床效果。
IV 级。
