Revision of a lumbar disc arthroplasty following late infection

Spivak, Jeffrey M.; Petrizzo, Anthony

doi:10.1007/s00586-009-1226-z

Cited by 21 publications

(29 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…One case of Streptococcus intermedius infection after a two-level TDA has been reported [6], treated by percutaneous abscess drainage and suppressive antibiotics. Despite favorable evolution, the patient wished to have his implants removed and converted to a fusion.…”

Section: Discussionmentioning

confidence: 99%

“…Infection after TDA is very uncommon [1,5] and to our knowledge this is the second report of an infection after TDA in literature [6]. As such, there are no standard, approved guidelines for the treatment of an infected TDA.…”

Section: Introductionmentioning

confidence: 90%

“…As such, there are no standard, approved guidelines for the treatment of an infected TDA. However, all mobile joint replacements have some incidence of late infection [6]. Depending on the time that has elapsed between the arthroplasty and the diagnosis of infection, treatment options may include longterm antibiotic therapy, open debridement, removal of the prosthesis and either exchange arthroplasty or joint fusion [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An uncommon case of Mycoplasma hominis infection after total disc replacement

Flouzat-Lachaniette¹,

Guidon²,

Allain³

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

Purpose Beside mechanical complications, the majority of adverse events after total disc arthroplasty (TDA) are related to the surgical approach. Septic complications are very uncommon and only one previous case has been published. The objective of this article is to describe the clinical circumstances, treatment, and outcomes of septic complication after TDA at L4-L5, involving an uncommon pathogen (Mycoplasma hominis). Methods A 38-year-old woman underwent a MobiDisc Ò TDA at L4-L5 level for discogenic pain. One month postoperatively, she complained of acute low back and abdominal pain associated with fever (39°C). C-reactive protein level was elevated (197 mg/L; normal \5 mg/L) and the white blood cell count was normal (7 9 10 9 /L; normal 4-10 9 10 9 /L). A computerized tomography (CT) showed a left psoas-based retroperitoneal abscess. Treatment consisted of open debridement, drainage and empirical antibiotic therapy. Intraoperative cultures yielded M. hominis after 7 days incubation. Antibiotic therapy was adapted and discontinued after 2 months. The patient had failed to mention earlier that she had been suffering from abnormal vaginal discharge for some time and was using an intrauterine contraceptive device. Results At 1.5-year follow-up, review confirmed healing of the infection with biological normalization without residual collection, radiolucent lines or osteolysis around the prosthesis at radiographs, CT and MRI.Conclusions Mycoplasma hominis can be involved as an extragenital pathogen in musculoskeletal infections. Because its culture and identification are difficult, special media and real-time PCR are required in case of postoperative deep wound infection after anterior lumbar spine surgery, especially in the case of previous genitourinary infections, to decrease the delay in diagnosis and treatment.

show abstract

“…With regard to infections involving disc replacements the literature is very sparse. There is a case of revision of a lumbar disc arthroplasty in the literature following late infection which was converted to a spinal fusion after the treatment of the surrounding retroperitoneal abscess [46]. When discussed further it is noted there is no standard algorithm for dealing with infected disc replacement.…”

Section: Spinal Implantsmentioning

confidence: 99%

Infections associated with spinal implants

Quaile

2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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.

show abstract

Revision of a lumbar disc arthroplasty following late infection

Cited by 21 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

An uncommon case of Mycoplasma hominis infection after total disc replacement

Infections associated with spinal implants

Contact Info

Product

Resources

About