Abstract
Background: Lumbar disc replacement is a good alternative to fusion in young patients with degenerative disc disease or discogenic back pain. Despite the increase in the use of anterior lumbar disc replacement, there has been little published data of the specific types and frequencies of the complications associated with its use.
Aims & Methods: Purpose of the study is to retrospectively study the perioperative complications associated with CHARITÉ® Artificial Disc replacement. The lumbar spine is retroperitoneally approached, viscera and major vessels retracted and the disc replaced. We reviewed the operative and hospital records of 54 charite disc replacements done by the senior author from 2004 till September 2006.
Results: The study group had 23 men and 31 women with a mean age of 38 years (range 31–47). Preoperative diagnosis was degenerative disc disease in 42 patients (78%); discogenic back pain in 12 patients (22%). The most common level replaced was L4/5 (48%) followed by L5/S1 (35%). The most common complication during the procedure was venous injury involving one of the left iliac vein tributary (9 patients, 16%). There was no arterial injury. The median blood loss was 450ml (100–1500ml). There was peritoneum breach in six patients, but no case of bowel, ureter, and bladder or kidney injury. There were two incidences of significant post operative ileus and one developed S1 radiculopathy from lateral disc placement. One developed incisional hernia and two patients had to be revised to fusion. Retrograde ejaculation was reported in 3 patients. No incidence of epidural vein bleed, CSF leak, infection, paraplegia or death.
Conclusions: Anterior spinal surgery is a relatively safe procedure with a lower complication rate than was previously reported. Vascular injury was the most frequent complication. The incidence of autonomous dysfunction affecting pelvic floor function appears to be under-estimated and needs further study.
Correspondence should be addressed to: Mr N. J. Henderson, BASS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
