Article
Early complications in lumbar arthroplasty
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Authors
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E. Fritsch
- Orthopädische Universitätsklinik, Homburg/Saar
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S. Gödde
- Homburg/Saar
| Published: | June 13, 2005 |
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Outline
Text
Introduction
In patients with discogenic pain with or without disc herniation the pain from the altered disc itself should be addressed if surgery is necessary. Spinal arthroplasty appears to be an alternative to a fusion chiefly because the preservation of segmental mobility is believed to be beneficial to prevent adjacent level degeneration.
Materials and Methods
As a part of a prospective study the clinical and radiological data of the first 15 lumbar disc prostheses (A-MAV, Medtronic Sofamor Danek) were reviewed towards early complications. All surgeries were performed by the senior spine surgeon using minimally invasive approaches. The biggest possible size of the prostheses was preoperatively determined with templates. The positioning of the implants was fluoroscopically controlled in 2 planes. Contraindications were strictly addressed. All Patients were below the age of 45 years. Follow up (clinical status, radiographic control) was 6 weeks, 3 month, 6 month and 1 year postoperative.
Results
14 prostheses were ideally placed. One prosthesis was positioned too far dorsally and had to be revised because of neurological deficiency. One prosthesis broke into an adjacent endplate without trauma without need for revision in a pain free patient. One prosthesis broke into an adjacent endplate one year p.o. due to a severe trauma requiring a dorsal fusion. 50% of all patients developed irritation of an ileosacral joint lasting about 3 month.
Discussion
The potential for complications in spinal arthroplasty seems to be higher than estimated. Therefore the indication should be kept very narrow because revision surgery is highly difficult.
