Visceral and Vascular Complications of Anterior Lumbar Disc Replacement

[Justin]

Eh, it's a retrospective study with a small sample size, but the title caught my eye...



The Spine Journal
Volume 7, Issue 5, Supplement 1, September-October 2007, Page 106S
Proceedings of the 22nd Annual Meeting of the North American Spine Society

Visceral and Vascular Complications of Anterior Lumbar Disc Replacement: Charité® Artificial Disc

Prabhat Lakkireddi1, Harichandana Panjugala2 and Gavin Marsh FRSC3

1Croydon, Surrey, United Kingdom
2Mayday University Hospital NHS Trust, Croydon, Surrey, United Kingdom
3Mayday University Hospital, Surrey, United Kingdom

BACKGROUND CONTEXT: Lumbar disc replacement is a good alternative to fusion in young patients with degenerative disc disease or discogenic back pain. Despite the increase in the use of anterior lumbar disc replacement, there has been little published data of the specific types and frequencies of the complications associated with its use. We presented our experience with Charité Artificial Disc.

PURPOSE: Purpose of the study is to retrospectively study the perioperative complications associated with CHARITÉ® Artificial Disc replacement.

STUDY DESIGN/SETTING: A retrospective analysis of 54 patients who underwent Charité Artificial Disc Replacement at Mayday University Hospital.

PATIENT SAMPLE: 54 patients were followed up retrospectively by reviewing clinical notes and anaesthetic records.

OUTCOME MEASURES: Main surgical complications were immediate and late approach related, and complications related to implantation of prosthesis. Complications were grouped as vascular, visceral and neurological (Sympathetic hypogastric plexus). Patients were followed up with Visual Analogue Pain score, Oswestry Disability Index, SF 36 Version 1. Bladder and bowel questionnaires was sent to both male and female patients. International Index of Erectile Function (IIEF) in Males and Female Sexual Function Index (FSFI) in females were analysed.

METHODS: The lumbar spine is retroperitoneally approached, viscera and major vessels retracted and the disc replaced. We reviewed the operative and hospital records of 54 Charité disc replacements done by the senior author from 2004 till November 2006.

RESULTS: The study group had 23 men and 31 women with a mean age of 38 years (range 31–47). Preoperative diagnosis was degenerative disc disease in 42 patients (78%); discogenic back pain in 12 patients (22%). The most common level replaced was L4/5 (48%) followed by L5/S1 (35%). The most common complication during the procedure was venous injury involving one of the left iliac vein tributary (9 patients, 16%). There was no arterial injury. The median blood loss was 450ml (100–1500ml). There was peritoneum breach in six patients, but no case of bowel, ureter, and bladder or kidney injury. There were two incidences of significant post operative ileus and one developed S1 radiculopathy from lateral disc placement. One developed incisional hernia and two patients had to be revised to fusion. Retrograde ejaculation was reported in 3 patients. No incidence of epidural vein bleed, CSF leak, infection, paraplegia or death.

CONCLUSIONS: This retrospective study showed our incidence of complications associated with anterior spinal surgery. The incidence of complications is much less, but cannot be compared as there is hardly any evidence in literature. Anterior spinal surgery is a relatively safe procedure with a lower complication rate than was previously reported. Vascular injury was the most frequent complication. But one complication that is autonomous dysfunction affecting pelvic floor function appears to be underestimated and needs further study.

FDA DEVICE/DRUG STATUS: Charité Artificial Disc Replacement: Approved for this indication.