Traumatic burst fracture in a patient with a lumbar artificial disc

Case report

Oren N. Gottfried Departments of Orthopaedics and Neurosurgery, University of Utah, Salt Lake City, Utah

Search for other papers by Oren N. Gottfried in
jns
Google Scholar
PubMed
Close
 M.D.
and
Darrel S. Brodke Departments of Orthopaedics and Neurosurgery, University of Utah, Salt Lake City, Utah

Search for other papers by Darrel S. Brodke in
jns
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $392.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $392.00
USD  $636.00
Print or Print + Online Sign in

Lumbar disc arthroplasty is now a common treatment for lumbar degenerative disc disease. Whereas the immediate and delayed complications in patients with artificial lumbar discs are well reported, the durability of artificial disc hardware after severe spine trauma is unknown. The authors describe the management of a rare case of a traumatic lumbar burst fracture in a patient who had undergone disc arthroplasty. This 31-year-old male contractor had undergone placement of an L4–5 Charité artificial disc (DePuy Spine) and L5–S1 anterior lumbar fusion 10 months before he fell from a roof and sustained a traumatic L-3 burst fracture with significant canal compromise and cauda equina injury. Despite the considerable compressive load on his spine, the artificial disc (L4–5) remained intact without any radiological signs of hardware failure, and the vertebrae above (L-4) and below (L-5) the artificial disc had no signs of injury. For the L-3 burst fracture the patient underwent an open decompressive laminectomy at L2–3 and posterior fusion with instrumentation from L-2 to L-4. At 24 months postinjury, he had returned to full work activities as a contractor with minimal back pain and mild right lower-extremity sensory changes and weakness left over from the trauma. The total disc arthroplasty at L4–5 is functional and has preserved motion, and there is a solid fusion at L2–4 and L5–S1. This case demonstrates that a lumbar artificial disc can tolerate a significant load from trauma and remain functional without hardware failure even after a traumatic burst fracture at the adjacent lumbar vertebral body and shows the successful treatment of this fracture, with posterior fusion preserving the motion of an artificial disc.

Abbreviation used in this paper:

TDR = total disc replacement.
  • Collapse
  • Expand
  • 1

    Auerbach JD, , Wills BP, , McIntosh TC, & Balderston RA: Evaluation of spinal kinematics following lumbar total disc replacement and circumferential fusion using in vivo fluoroscopy. Spine 32:527536, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bertagnoli R, , Yue JJ, , Fenk-Mayer A, , Eerulkar J, & Emerson JW: Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total disc arthroplasty by using the prodisc prosthesis: a prospective study with 2-year minimum follow up. J Neurosurg Spine 4:9197, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bertagnoli R, , Zigler J, , Karg A, & Voigt S: Complications and strategies for revision surgery in total disc replacement. Orthop Clin North Am 36:389395, 2005

  • 4

    Blumenthal S, , McAfee PC, , Guyer RD, , Hochschuler SH, , Geisler FH, & Holt RT, et al.: A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine 30:15651575, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Chang BS, , Brown PR, , Sieber A, , Valdevit A, , Tateno K, & Kostuik JP: Evaluation of the biological response of wear debris. Spine J 4:239S244S, 2004

  • 6

    Cunningham B, , Demuth G, , McAfee PC, , Scott-Young M, , Yoon K, & Blumenthal S, et al.: Survivorship analysis of the Charite artificial disc: review of 1,938 patients from eight leading international spine centers. Spine J 7:Suppl 81S82S, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Cunningham BW, , Gordon JD, , Dmitriev AE, , Hu N, & McAfee PC: Biomechanical evaluation of total disc replacement arthroplasty: an in vitro human cadaveric model. Spine 28:S110S117, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    David T: Long-term results of one-level lumbar arthroplasty: minimum 10-year follow-up of the CHARITE artificial disc in 106 patients. Spine 32:661666, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Etebar S, & Cahill DW: Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90:163169, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Griffith SL, , Shelokov AP, , Buttner-Janz K, , LeMaire JP, & Zeegers WS: A multicenter retrospective study of the clinical results of the LINK SB Charite intervertebral prosthesis. The initial European experience. Spine 19:18421849, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Guyer RD, , McAfee PC, , Hochschuler SH, , Blumenthal SL, , Fedder IL, & Ohnmeiss DD, et al.: Prospective randomized study of the Charite artificial disc: data from two investigational centers. Spine J 4:252S259S, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Ha KY, & Kim YH: Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine 28:E158E160, 2003

  • 13

    Hirano T, , Hasegawa K, , Washio T, , Hara T, & Takahashi H: Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord 11:493497, 1998

  • 14

    Huang RC, , Girardi FP, , Cammisa FP Jr, , Lim MR, , Tropiano P, & Marnay T: Correlation between range of motion and outcome after lumbar total disc replacement: 8.6-year follow-up. Spine 30:14071411, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Huang RC, , Tropiano P, , Marnay T, , Girardi FP, , Lim MR, & Cammisa FP Jr: Range of motion and adjacent level degeneration after lumbar total disc replacement. Spine J 6:242247, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Kostuik JP: Complications and surgical revision for failed disc arthroplasty. Spine J 4:289S291S, 2004

  • 17

    Kurtz SM, , Peloza J, , Siskey R, & Villarraga ML: Analysis of a retrieved polyethylene total disc replacement component. Spine J 5:344350, 2005

  • 18

    Kurtz SM, , van Ooij A, , Ross R, , de Waal Malefijt J, , Peloza J, & Ciccarelli L, et al.: Polyethylene wear and rim fracture in total disc arthroplasty. Spine J 7:1221, 2007

  • 19

    Lee CK, & Goel VK: Artificial disc prosthesis: design concepts and criteria. Spine J 4:209S218S, 2004

  • 20

    Lehman RA Jr, & Lenke LG: Long-segment fusion of the thoracolumbar spine in conjunction with a motion-preserving artificial disc replacement: case report and review of the literature. Spine 32:E240E245, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    LeHuec JC, , Kiaer T, , Friesem T, , Mathews H, , Liu M, & Eisermann L: Shock absorption in lumbar disc prosthesis: a preliminary mechanical study. J Spinal Disord Tech 16:346351, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Lemaire JP, , Carrier H, , Sariali el-H, , Skalli W, & Lavaste F: Clinical and radiological outcomes with the Charite artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech 18:353359, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Levine DS, , Dugas JR, , Tarantino SJ, & Boachie-Adjei O: Chance fracture after pedicle screw fixation. A case report. Spine 23:382386, 1998

  • 24

    Mathew P, , Blackman M, , Redla S, & Hussein AA: Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine 30:E311E314, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    McAfee PC, , Cunningham B, , Holsapple G, , Adams K, , Blumenthal S, & Guyer RD, et al.: A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. Spine 30:15761583, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    McAfee PC, , Geisler FH, , Saiedy SS, , Moore SV, , Regan JJ, & Guyer RD, et al.: Revisability of the CHARITE artificial disc replacement: analysis of 688 patients enrolled in the U.S. IDE study of the CHARITE Artificial Disc. Spine 31:12171226, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Missori P, , Ramieri A, , Costanzo G, , Peschillo S, , Paolini S, & Miscusi M, et al.: Late vertebral body fracture after lumbar transpedicular fixation. Report of three cases. J Neurosurg Spine 3:5760, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Punt IM, , Visser VM, , van Rhijn LW, , Kurtz SM, , Antonis J, & Schurink GW, et al.: Complications and reoperations of the SB Charite lumbar disc prosthesis: experience in 75 patients. Eur Spine J 17:3643, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Putzier M, , Funk JF, , Schneider SV, , Gross C, , Tohtz SW, & Khodadadyan-Klostermann C, et al.: Charite total disc replacement—clinical and radiographical results after an average follow-up of 17 years. Eur Spine J 15:183195, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Serhan HA, , Dooris AP, , Parsons ML, , Ares PJ, & Gabriel SM: In vitro wear assessment of the Charite Artificial Disc according to ASTM recommendations. Spine 31:19001910, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Shim CS, , Lee S, , Maeng DH, & Lee SH: Vertical split fracture of the vertebral body following total disc replacement using Pro-Disc: report of two cases. J Spinal Disord Tech 18:465469, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Shim CS, , Lee SH, , Shin HD, , Kang HS, , Choi WC, & Jung B, et al.: CHARITE versus ProDisc: a comparative study of a minimum 3-year follow-up. Spine 32:10121018, 2007

  • 33

    Tortolani PJ, , Cunningham BW, , Eng M, , McAfee PC, , Holsapple GA, & Adams KA: Prevalence of heterotopic ossification following total disc replacement. A prospective, randomized study of two hundred and seventy-six patients. J Bone Joint Surg Am 89:8288, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Trouillier H, , Kern P, , Refior HJ, & Muller-Gerbl M: A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITE Artificial Disc. Eur Spine J 15:174182, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    van Ooij A, , Kurtz SM, , Stessels F, , Noten H, & van Rhijn L: Polyethylene wear debris and long-term clinical failure of the Charite disc prosthesis: a study of 4 patients. Spine 32:223229, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    van Ooij A, , Oner FC, & Verbout AJ: Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord Tech 16:369383, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Zigler J, , Delamarter R, , Spivak JM, , Linovitz RJ, , Danielson GO III, & Haider TT, et al.: Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32:11551163, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 784 214 96
Full Text Views 106 20 1
PDF Downloads 84 4 1
EPUB Downloads 0 0 0