The re-operation rate for lumbar total disc replacement was relatively low compared to rates reported for instrumented lumbar fusion. An analysis of re-operations after lumbar total disc replacement was presented by Jack E Zigler, Texas Back Institute, Texas, at the NASS annual meeting in Orlando, USA.
The study reviewed re-operations in a consecutive series of the first 1,000 patients undergoing lumbar total disc replacement at a single centre, representing the first total disc replacement case experience for 11 surgeons from one multisite clinic.
Patients were identified from FDA IDE study records and electronic surgery log. The first case was in March 2000 and 1,000th case was in February 2009. Male patients (56.2%), female (43.8%) and mean age was 40.1(18–64). Mean follow-up rate was 54 months.
Five hundred and seventy one patients (57.1%) were involved in an IDE trial and 429 patients (42.9%) were not involved. Seventy nine (7.9%) patients had re-operations. Of the 122 procedures, there were 48 SCS/pump trials, implants, and/or revisions in 31 patients and 74 traditional re-operations in 60 patients; 12 patients had SCS and traditional re-operations, which were counted in both groups.
In 28 patients (2.8%) the re-operation involved the index total disc replacement level. Of 1,207 levels implanted with total disc replacements, re-operation at 30 levels (2.5%). Duration from index surgery to first re-operation was mean 21.8 months and range two days to 7.6 years. Anterior re-operation was undertaken at the index level in only 13 of 1,000 (1.3%) patients. All re-operations were performed as planned without additional complication.
“Despite initial fears about increased re-operations due to new technology demanding more precise placement, anterior revision surgery following lumbar artificial disc replacement is rarely required, and, with appropriate cautions and trained personnel, can generally be accomplished safely,” Zigler concluded.
