ARTIFICIAL DISC REPLACEMENT AND OSTEOLYSIS

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 reports 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 reported².

Methods: We present what we believe is the first histologically proven case of significant Osteolysis associated with artificial disc replacement in the world literature. We also present a literature review of the laboratory research into performance of artificial disc replacement, focusing on wear debris and particle generation.

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 Charite disc prosthesis. In May of 2002 she developed significant back pain, and further investigation, including biopsy 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. We report an important complication associated with the use of artificial disc replacement. Revision of such prostheses is challenging, and we advise a combined surgical approach.