Purpose: To compare mid-term clinical outcomes of two revision strategies for patients with failed SB Charité III total disc replacements (TDRs).
Methods: Eighteen patients with a failed TDR underwent posterolateral instrumented fusion (fusion group); in 21 patients, the TDR was removed and the intervertebral defect was filled with a bone strut graft, followed by an instrumented posterolateral fusion (removal group). Visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed.
Results: Mean follow-up was 3.7 years (range 1.0-6.4) in the removal group and 4.4 years (range 0.7-11.0) in the fusion group. Although the removal group showed a significantly lower VAS and ODI score post-revision surgery as compared to preoperative (P < 0.01 and P = 0.01, respectively), no significant differences were found between the removal and fusion groups before and after revision surgery in VAS and ODI. A clinical relevant improvement in VAS and ODI was found in 47 and 21 % respectively in the removal group, and in 22 and 27 % respectively in the fusion group. Substantial complications were observed only in the removal group.
Conclusions: Both procedures showed improvement clinically. There were no significant additional benefits of removing the TDR as compared to fusion alone at mid-term follow-up. The clinical decision to remove the TDR should be carefully weighed up against potential risks and complications of this procedure.