Revision of a lumbar disc arthroplasty following late infection

Anterior removal of a lumbar total disc replacement implant is often a very technically demanding procedure. The anterior retroperitoneal anatomy is prone to scarring, limiting remobilization and making a direct anterior exposure above the L5-S1 level difficult if not impossible to achieve safely. Anterolateral approach strategies can be more safely achieved at L4-L5 and above, but may require vertebral osteotomy in order to remove a keeled prosthesis. Successful conversion to a fusion with implant removal can be achieved, even when osteotomy is needed for implant removal. This Grand Rounds case presentation involves an unusual late retroperitoneal abscess following two-level TDR with direct extension to one of the implants, and the subsequent nonoperative and operative management. Removal of a well-fixed keeled implant at the L4-L5 level following nonoperative treatment of a surrounding retroperitoneal abscess and conversion to fusion represents close to, if not a ‘worst-case’ scenario for revision TDR. However, with proper preoperative planning and surgical experience, a safe and successful procedure can be the end result

Keywords : Abscess,Adult,adverse effects,Arthroplasty,Arthroplasty,Replacement,diagnostic imaging,Disability Evaluation,etiology,Gastrointestinal Diseases,Humans,Intervertebral Disc,Intervertebral Disc Displacement,Joint Diseases,Low Back Pain,Lumbar Vertebrae,Male,Osteotomy,Radiography,Reoperation,Retroperitoneal Space,Spinal Fusion,Spine,Staphylococcal Infections,surgery,Total Disc Replacement,Treatment Outcome,, Lumbar,Disc,Arthroplasty, zydol tablets what are they for

Date of Publication : 2010 May

Authors : Spivak JM;Petrizzo AM;

Organisation : NYU Hospital for Joint Diseases Spine Center, 301 East 17th Street, New York, NY 10003, USA. jeffrey.spivak@nyumc.org

Journal of Publication : Eur Spine J

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/19937351

The London Spine Unit : Harley Street UK. Specialists in Cutting Edge Technologies for Spinal Surgery

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