Advertisement

Topics

L5-S1 disc replacement after two previous fusion surgeries for scoliosis.

Summary of "L5-S1 disc replacement after two previous fusion surgeries for scoliosis."

Following scoliosis surgery, lumbar motion segment degeneration below the level of fusion is not uncommon. Especially long fusions extending to the mid and lower lumbar spine increase the likelihood of degeneration of the remaining motion segments. The management for these patients is controversial and depends on the clinical presentation and level of degeneration. The increasing confidence in motion-preserving technology leads to a dilemma on whether to fuse the remaining lumbar levels or risk utilising disc arthroplasty to preserve the remaining motion segments and facilitate coronal balance in patients with previous long fusion for scoliosis. We present an interesting case of a 44-year-old lady, who underwent two-stage corrective surgery for progressive idiopathic scoliosis at the age of 22 years. In the first stage, she had T11-L3 anterior fusion, whilst in the second stage posterior fusion was done from T5 to L3. At 22 years after the initial surgery, she presented with worsening low back pain and bilateral L4 radicular symptoms. MRI scan confirmed severe disc degeneration at L3-4 and L5-S1 levels with preserved L4-5 disc. She initially underwent L3-L4 decompression and posterolateral fusion at that level, which relieved her radicular symptoms. However, she had persistent pain at the lumbosacral junction with Modic I changes. The options of an anterior L5-S1 fusion or disc replacement were considered and discussed with the patient. The disc replacement option was decided upon with the patient, as anterior fusion was judged to increase the risk of coronal imbalance. At the 1-year follow-up, she reported significant improvement in the back pain. The radiographs at 1 year showed satisfactory position and function of the artificial disc replacement. The disc was flexed laterally, accommodating the coronal balance of the spine. We conclude that L5-S1 motion segment can be preserved with artificial disc replacement in patients with previous long fusion for scoliosis surgery. The real difficulty arises when choosing between disc replacement and extension of fusion. In our patient, the disc replacement has worked well so far. However, the disc is clearly at a mechanical disadvantage, and loss of function in the mid- or long term would not be surprising.

Affiliation

Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham, UK.

Journal Details

This article was published in the following journal.

Name: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the Euro
ISSN: 1432-0932
Pages:

Links

DeepDyve research library

PubMed Articles [8868 Associated PubMed Articles listed on BioPortfolio]

Total Disc Replacement in Lumbar Degenerative Disc Diseases.

More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). I...

Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain.

Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diag...

Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease: 5-Year Follow-up.

The cervical total disc replacement (cTDR) was developed to treat cervical degenerative disc disease while preserving motion.

345 Elective Anterior Cervical Discectomy and Fusion vs Cervical Artificial Disc Replacement: A Comparison of Perioperative Morbidity and Early Outcomes.

We conducted a retrospective cohort analysis of early outcomes after elective anterior cervical discectomy and fusion (ACDF) vs cervical artificial disc replacement (C-ADR) using the National Surgical...

Impact of Increasing Age on Outcomes of Spinal Fusion in Adult Scoliosis.

To investigate the role of advancing age on postoperative complications and revision surgery following fusion for scoliosis.

Clinical Trials [2852 Associated Clinical Trials listed on BioPortfolio]

Clinical Outcome After Anterior Cervical Decompression and Fusion and Cervical Total Disc Replacement

The aim of this study is to examine the clinical outcome after anterior cervical decompression and fusion, and cervical disc prostheses in general. Additionally these two surgical methods ...

MAVERICK™ Total Disc Replacement- Pivotal Study

The purpose of this clinical trial is to assess the safety and effectiveness of the MAVERICK™ Total Disc Replacement as a method of treating patients with lumbar degenerative disc diseas...

A Clinical Trial Evaluating a Total Disc Replacement in Patients With Cervical Disc Disease

This study will be a non-randomized trial consisting of patients with single level (C3 to C7) symptomatic cervical disc disease who have not previously received fusion surgery at the same ...

PRESTIGE Observational Study

Prestige artificial disc replacement is an alternative treatment option with 16 years of experience addressing the unmet needs of surgical fusion interventions. Previous studies on the PRE...

InterFuse® S and T for the Treatment of Scoliosis, Spondylolisthesis and DDD

The primary objective of this prospective, post-market study is to collect data to assess the long term outcome of a broad contact modular interbody device in the form of the InterFuse S...

Medical and Biotech [MESH] Definitions

Abnormal growths of tissue that follow a previous neoplasm but are not metastases of the latter. The second neoplasm may have the same or different histological type and can occur in the same or different organs as the previous neoplasm but in all cases arises from an independent oncogenic event. The development of the second neoplasm may or may not be related to the treatment for the previous neoplasm since genetic risk or predisposing factors may actually be the cause.

Therapeutic replacement or supplementation of defective or missing enzymes to alleviate the effects of the enzyme deficiency (e.g., GLUCOSYLCERAMIDASE replacement for GAUCHER DISEASE).

The GENETIC RECOMBINATION of the parts of two or more GENES resulting in a gene with different or additional regulatory regions, or a new chimeric gene product. ONCOGENE FUSION includes an ONCOGENE as at least one of the fusion partners and such gene fusions are often detected in neoplastic cells and are transcribed into ONCOGENE FUSION PROTEINS. ARTIFICIAL GENE FUSION is carried out in vitro by RECOMBINANT DNA technology.

Electrophoresis in which discontinuities in both the voltage and pH gradients are introduced by using buffers of different composition and pH in the different parts of the gel column. The term 'disc' was originally used as an abbreviation for 'discontinuous' referring to the buffers employed, and does not have anything to do with the shape of the separated zones.

The GENETIC RECOMBINATION of the parts of two or more GENES, including an ONCOGENE as at least one of the fusion partners. Such gene fusions are often detected in neoplastic cells and are transcribed into ONCOGENE FUSION PROTEINS.

Quick Search
Advertisement
 


DeepDyve research library

Relevant Topics

Rheumatology
Arthritis Fibromyalgia Gout Lupus Rheumatic Rheumatology is the medical specialty concerned with the diagnosis and management of disease involving joints, tendons, muscles, ligaments and associated structures (Oxford Medical Diction...

Orthopedics
Arthroplasty Joint Disorders Orthopedics Spinal Cord Disorders Orthopedics is the science or practice of correcting deformities caused by disease or damage to the bones and joints of the skeleton. This specialized branch of surgery may ...


Searches Linking to this Article