Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

• Published in: European spine journal 2012-06, Vol.21 (Suppl 4), p.513-520
• Main Authors: Austen, Shennah, Punt, Ilona M., Cleutjens, Jack P. M., Willems, Paul C., Kurtz, Steven M., MacDonald, Daniel W., van Rhijn, Lodewijk W., van Ooij, André
• Format: Article
• Language: English
• Subjects: Adhesives; Case Report; Degeneration; Female; Giant cells; Humans; Inflammation; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - pathology; Intervertebral Disc - surgery; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Degeneration - pathology; Intervertebral Disc Degeneration - surgery; Intervertebral discs; Joint diseases; Leg; Low Back Pain - diagnostic imaging; Low Back Pain - pathology; Low Back Pain - surgery; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - pathology; Lumbar Vertebrae - surgery; Macrophages; Male; Medicine; Medicine & Public Health; Middle Aged; Molecular weight; Neurosurgery; Pain; Polyethylene; Radiography; Spinal Fusion; Spine (lumbar); Subsidence; Surgery; Surgical Orthopedics; Total Disc Replacement - methods; Treatment Outcome
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-011-2141-7

Introduction This study evaluates the short-term clinical outcome, radiological, histological and device retrieval findings of two patients with second generation lumbar total disc replacement (TDR). Materials and methods The first patient had a single level L4-L5 Activ-L TDR, the second patient a L4-L5 Mobidisc and L5-S1 Activ-L TDR. The TDRs were implanted elsewhere and had implantation times between 1.3 and 2.8 years. Results Plain radiographs and CT-scanning showed slight subsidence of the Activ-L TDR in both patients and facet joint degeneration. The patients underwent revision surgery because of recurrent back and leg pain. After removal of the TDR and posterolateral fusion, the pain improved. Histological examination revealed large ultrahigh molecular weight polyethylene (UHMWPE) particles and giant cells in the retrieved tissue surrounding the Mobidisc. The particles in the tissue samples of the Activ-L TDR were smaller and contained in macrophages. Retrieval analysis of the UHMWPE cores revealed evidence of minor adhesive and abrasive wear with signs of impingement in both TDR designs. Conclusion Although wear was unrelated to the reason for revision, this study demonstrates the presence of UHMWPE particles and inflammatory cells in second generation TDR. Long-term follow-up after TDR is indicated for monitoring wear and implant status.