Disc herniation caused by a viscoelastic nucleus after total lumbar disc replacement—a case report

J Spine Surg, 2018 · DOI: 10.21037/jss.2018.05.21 · Published: June 1, 2018

Simple Explanation

Degenerative disc disease (DDD) is a common issue that can lead to back pain. If conservative treatments don't work, surgery, such as spinal fusion, may be considered. Total disc replacement (TDR) is another surgical option for some patients with DDD. This case report describes a rare complication following TDR where the viscoelastic nucleus of the artificial disc herniated, causing nerve compression. The patient required additional surgeries to address this issue. Although TDR can be beneficial, surgeons need to be aware of potential problems with the devices. This case underscores the importance of considering device-related complications in patients who have undergone TDR.

Study Duration

2 years

Participants

One 34-year-old male

Evidence Level

Level 4, Case Report

Key Findings

1
The case report presents an unreported complication of lumbar TDR involving herniation of the viscoelastic nucleus, mimicking a disc herniation.
2
Initial sequestrectomy was insufficient, requiring subsequent removal of the TDR and interbody fusion with posterior instrumentation.
3
The patient developed adjacent segment disease with facet syndromes two years after the fusion, highlighting a potential long-term consequence.

Research Summary

This case report describes a rare complication of total lumbar disc replacement (TDR), where the viscoelastic nucleus of the artificial disc herniated, causing nerve compression and radiculopathy. The patient initially underwent sequestrectomy, but the problem recurred, necessitating removal of the TDR device and replacement with interbody fusion and posterior instrumentation. Despite resolution of the radiculopathy, the patient developed adjacent segment disease and facet syndromes two years post-fusion, illustrating potential long-term complications associated with both TDR and subsequent fusion procedures.

Practical Implications

Device Selection

Surgeons should carefully consider the design and potential failure modes of TDR devices when selecting implants.

Post-operative Monitoring

Close monitoring and early imaging are crucial for patients with TDR who develop recurrent or new neurological symptoms.

Alternative Surgical Options

Interbody fusion should be considered as a primary option for failure of TDR.

Study Limitations

1
Single case report
2
Limited long-term follow-up data
3
Device removed from the market

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