Center for Disc Replacement at Texas Back Institute, 6020 W Parker Rd #200, Plano, TX, 75093, USA.
Texas Back Institute Research Foundation, Plano, TX, USA.
Eur Spine J. 2024 Aug;33(8):3117-3123. doi: 10.1007/s00586-024-08402-7. Epub 2024 Jul 18.
To describe modes of failure of cervical TDR, their related treatment strategies, and to describe a management strategy for the treatment of failed cervical TDR.
This retrospective study was based on a consecutive series of 53 cervical TDR patients who underwent removal or revision surgery. Chart review was conducted to collect general descriptive data, reasons for TDR removal/revision, duration from index implantation to re-operation, and the subsequent procedure performed.
Among 53 patients, 36 underwent TDR removal and fusion, 16 underwent TDR removal and replacement with another TDR, and one patient's TDR was revised by repositioning. The mean duration from index surgery to removal/revision was 40.1 months (range: 3 days-222 months). In all cases, removal/revision surgery was completed without complication. The most common reason for removal was severe osteolysis, often involving C. acnes infection, and was primarily associated with one implant type. TDR removal and fusion were performed for subsidence, device migration, treatment of symptoms arising from posterior anatomy (facet joints, etc.), approach-related complications and pain. TDR replacement was feasible for hypermobility, metal allergy, implant locked in kyphosis, and oversized implant use. In one case of TDR malpositioning, the device was successfully revised into appropriate position.
After cervical TDR failure, replacing a TDR with another implant can be feasible. Reasons for revision or removal after cervical TDR surgery include biomechanical failure, implant migration, surgeon or technical error, or biological reasons. The type of failure can help the surgeon create a strategy to address these complications.
描述颈椎 TDR 失败的模式、相关的治疗策略，并描述一种治疗失败的颈椎 TDR 的管理策略。
本回顾性研究基于连续的 53 例颈椎 TDR 患者，这些患者均接受了移除或翻修手术。对图表进行回顾性研究，以收集一般描述性数据、TDR 移除/翻修的原因、从指数植入到再次手术的时间以及随后进行的手术。
在 53 例患者中，36 例行 TDR 移除和融合，16 例行 TDR 移除并用另一个 TDR 替换，1 例患者的 TDR 通过重新定位进行修正。从初次手术到移除/翻修的平均时间为 40.1 个月（范围：3 天-222 个月）。所有病例均顺利完成移除/翻修手术，无并发症。移除/翻修的最常见原因是严重的骨溶解，常涉及 C. acnes 感染，主要与一种植入物类型有关。TDR 移除和融合用于沉降、器械迁移、治疗来自后解剖结构（关节突关节等）的症状、与入路相关的并发症和疼痛。对于过度活动、金属过敏、植入物锁定在后凸、使用过大的植入物，可进行 TDR 置换。在 1 例 TDR 错位的情况下，成功地将器械修正到适当的位置。
颈椎 TDR 失败后，另一个植入物可以更换。颈椎 TDR 手术后需要进行翻修或移除的原因包括生物力学失败、植入物迁移、术者或技术失误或生物学原因。失败的类型可以帮助术者制定策略来解决这些并发症。
