Expert’s comment concerning Grand Rounds case entitled “Revision of a lumbar disc arthroplasty following late infection” (by Jeffrey M. Spivak and Anthony M. Petrizzo)

Tropiano, Patrick

doi:10.1007/s00586-009-1225-0

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…With acceptable implant status and position, posterior fusion can be addressed for treatment of recurrent back pain due to facet joint degeneration [44,45]. When the TDR has subsided, migrated or mechanically failed, the pain can be addressed by TDR removal [45].…”

Section: Discussionmentioning

confidence: 99%

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Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

et al. 2012

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Introduction This study evaluates the short-term clinical outcome, radiological, histological and device retrieval findings of two patients with second generation lumbar total disc replacement (TDR). Materials and methods The first patient had a single level L4-L5 Activ-L TDR, the second patient a L4-L5 Mobidisc and L5-S1 Activ-L TDR. The TDRs were implanted elsewhere and had implantation times between 1.3 and 2.8 years.Results Plain radiographs and CT-scanning showed slight subsidence of the Activ-L TDR in both patients and facet joint degeneration. The patients underwent revision surgery because of recurrent back and leg pain. After removal of the TDR and posterolateral fusion, the pain improved. Histological examination revealed large ultrahigh molecular weight polyethylene (UHMWPE) particles and giant cells in the retrieved tissue surrounding the Mobidisc. The particles in the tissue samples of the Activ-L TDR were smaller and contained in macrophages. Retrieval analysis of the UHMWPE cores revealed evidence of minor adhesive and abrasive wear with signs of impingement in both TDR designs. Conclusion Although wear was unrelated to the reason for revision, this study demonstrates the presence of UHMWPE particles and inflammatory cells in second generation TDR. Long-term follow-up after TDR is indicated for monitoring wear and implant status.

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Section: Discussionmentioning

confidence: 99%

“…There is an ongoing discussion about the optimal revision strategy for failed TDRs [21,[43][44][45]. With acceptable implant status and position, posterior fusion can be addressed for treatment of recurrent back pain due to facet joint degeneration [44,45].…”

Section: Discussionmentioning

confidence: 99%

Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

et al. 2012

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“…Like any orthopedic or spinal procedure, TDR carries the risk of deep infection. This includes both acute infection with virulent organisms (typically occurring within 3 months) and delayed/chronic infections that may present months or years after the TDR procedure [ 8 , 9 ]. Diagnosis of the latter is notably challenging due to the subtlety of common symptoms like pain and implant loosening compared to the more obvious symptoms associated with acute infection (e.g., swelling, fluid accumulation, and fever) [8] .…”

Section: Introductionmentioning

confidence: 99%

“…This includes both acute infection with virulent organisms (typically occurring within 3 months) and delayed/chronic infections that may present months or years after the TDR procedure [ 8 , 9 ]. Diagnosis of the latter is notably challenging due to the subtlety of common symptoms like pain and implant loosening compared to the more obvious symptoms associated with acute infection (e.g., swelling, fluid accumulation, and fever) [8] . Although TDR infection, particularly delayed infection, is reported to be uncommon relative to large joint arthroplasty, the results can be devastating.…”

Section: Introductionmentioning

confidence: 99%

Presentation and management of infection in total disc replacement: A review

Spece,

Khachatryan,

Phillips

et al. 2024

North American Spine Society Journal (NASSJ)

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Infections associated with spinal implants

Quaile

2012

International Orthopaedics (SICOT)

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Spinal infections represent a difficult challenge to treating clinicians. Infections in the presence of implants are even more so. In this review the literature appears to reflect a change of practice in which the aim is to retain implants if possible. The newer spinal procedures such as disc replacements pose different problems largely due to the more difficult access. The situation in the spine is more difficult than in general orthopaedics when dealing with infection due to the requirement for stability and to protect neurological function. The main thrust of management, therefore, is early diagnosis and a high index of suspicion followed by adequate if not radical management in a multidisciplinary setting. In the event prevention is better than cure and therefore consideration of the various mechanisms to avoid infection must be taken. There are some 'novel' considerations for the avoidance of infection alongside the tried and tested techniques. There are also new procedures for wound closure and the elimination of dead space.

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Expert’s comment concerning Grand Rounds case entitled “Revision of a lumbar disc arthroplasty following late infection” (by Jeffrey M. Spivak and Anthony M. Petrizzo)

Cited by 5 publications

References 12 publications

Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

Presentation and management of infection in total disc replacement: A review

Infections associated with spinal implants

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