Abstract
Introduction: Prosthetic disc surgery is a rapidly growing field in patients with symptomatic degenerative disc disease. Few reports of long-term follow up are yet published, but several authors have published case series including a report of significant complications and difficulties with revision surgery1. Advocates of disc replacement surgery have claimed that osteolysis, whilst being a potential problem associated with artificial disc replacement, has not yet been reported.
Methods: The literature relating to the laboratory research into performance of artificial disc replacement, focusing on wear debris and particle generation is reviewed. Reports of complications are reviewed. A case of significant osteolysis associated with artificial disc replacement is reported.
Results: Our report involves a 42-year-old lady with degenerative disc disease who underwent L5/S1 anterior lumbar interbody fusion in July 1999, with a simultaneous L4/L5 Charité disc prosthesis. In May of 2002 she developed significant back pain, and further investigation revealed polymer disintegration and associated osteolysis. Attempted revision surgery in May 2003, using a combined anterior approach by a vascular and spinal surgeon, led to damage to the adherent common iliac vessels and inferior vena cava, and the attempt to remove the prosthesis was abandoned. Histological samples taken at surgery confirmed the presence of polyethylene wear debris. Posterior instrumented fusion was performed in June 2003 and the patient made a successful recovery.
Discussion: It is important in modern spinal practice to be fully aware of both reported and potential risks of the use of new prostheses. Wear of an artificial disc causing osteolysis is anticipated. This is believed to be the first case in the world literature of this important complication associated with the use of artificial disc replacement. Revision of disc prostheses with osteoly-sis is challenging, and a combined surgical approach is advised.
The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.
References:
1 van Ooij A, Oner FC, Verbout AJ. Complications of artificial disc replacement: a report of 27 patients with the SB Charité disc. J Spinal Disord Tech. 2003;16:369–83. Google Scholar
