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Clinical outcomes of two revision strategies for failed total disc replacements

PURPOSE: To compare mid-term clinical outcomes of two revision strategies for patients with failed SB Charité III total disc replacements (TDRs). METHODS: Eighteen patients with a failed TDR underwent posterolateral instrumented fusion (fusion group); in 21 patients, the TDR was removed and the inte...

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Detalles Bibliográficos
Autores principales: Punt, Ilona, Willems, Paul, Kurtz, Steven, van Rhijn, Lodewijk, van Ooij, André
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer-Verlag 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508220/
https://www.ncbi.nlm.nih.gov/pubmed/22576159
http://dx.doi.org/10.1007/s00586-012-2354-4
Descripción
Sumario:PURPOSE: To compare mid-term clinical outcomes of two revision strategies for patients with failed SB Charité III total disc replacements (TDRs). METHODS: Eighteen patients with a failed TDR underwent posterolateral instrumented fusion (fusion group); in 21 patients, the TDR was removed and the intervertebral defect was filled with a bone strut graft, followed by an instrumented posterolateral fusion (removal group). Visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed. RESULTS: Mean follow-up was 3.7 years (range 1.0–6.4) in the removal group and 4.4 years (range 0.7–11.0) in the fusion group. Although the removal group showed a significantly lower VAS and ODI score post-revision surgery as compared to preoperative (P < 0.01 and P = 0.01, respectively), no significant differences were found between the removal and fusion groups before and after revision surgery in VAS and ODI. A clinical relevant improvement in VAS and ODI was found in 47 and 21 % respectively in the removal group, and in 22 and 27 % respectively in the fusion group. Substantial complications were observed only in the removal group. CONCLUSIONS: Both procedures showed improvement clinically. There were no significant additional benefits of removing the TDR as compared to fusion alone at mid-term follow-up. The clinical decision to remove the TDR should be carefully weighed up against potential risks and complications of this procedure.