L5/S1 LP- ESP artificial disc replacement complications with a patient in Australia that resulted in Prosthetic Osteolysis/ loosing of the implant and resulting in the patient needing risky removal of artificial disc replacement and getting it fused.
Prosthetic Osteolysis is a risk or complication not needed to be told to patients associated with artificial disc replacements surgery but is becoming more common especially in younger people due to younger people being more active and etc, this complication is more known in knee and hip replacements and this has to be told to all patients as a risk before these surgeries as it’s a 10% chance this can happen and revision surgery will be needed.
Prosthetic Osteolysis occurs when wear particles from the implant which could be polyethylene or metal fragments get into the surrounding tissue and surrounding bone and causes a inflammatory response from your body due to a foreign body reaction and makes that bone to break down and the implant to come loose, unfortunately this complication normally occurs years after surgery but early changes can be seen on correct scanning such as CT and a bone scan as MRI scans won’t show up to much due to the metal shadowing from the implant.
The major risk and issue with this complication in artificial disc replacement revision surgery is most surgeons don’t like to fix other surgeons problems and the original surgeon in this case refused to state their was a problem, unlike knee and hip replacement revision surgery for this problem which is not as complicated but revision surgery in the spine for this problem is extremely risky and sometimes the artificial disc can’t be removed and they have to leave the disc in and fuse around it.
In this case the patient suffered with major back pain, instability, nerve issues in both legs, dizziness, unbalancing and even blurry vision for over 2 years, he seen 4 specialists who did not want to help and went back to the original hospital 5 times and was sent home saying nothing was wrong until he found a incredible Surgeon who has seen this problem before and said it’s becoming more common and should not be happening but it is.
Pathology report results from this patient taking during the revision surgery of his surrounding tissue and vertebrae fragments found multiple infections including Giant cell macrophages and evidence of a foreign body reaction as metal fragments were found in the surrounding tissue and vertebrae fragments.
Currently this case is in the hands of the Qld health ombudsman and the Australian medical association as they have requested the original surgeon, hospital and the supplier of the artificial disc a full review and report on why this happened, the care that was not supplied and why is this risk and complication not on and needed on the consent forms here in Australia.
The patient is now 3 weeks post opp from the removal of the artificial disc replacement and fusion added and is doing well with a lot of his issues now gone but won’t know the full outcome for another 3 to 6 months.
The ESP Disc Replacement is a mono-bloc total disc replacement implant that restores natural disc functions.
The ESP disc replacement is made of 2 titanium alloy end-plates and an elasto-meric cushion. The spikes on the end-plates outer surfaces improve primary fixation. The combination of a hydroxyapatite (HA) coating on top of a T40 rough surface are considered as one of the best existing coating. The titanium alloy used for the end plates allows clear medical imaging and guarantees good bony fixation over time.
• Between the 2 titanium end-plates the elsatomeric parts are injected for controled resistance to compression, flexion and rotation. These elastomeric parts are concentric and their fixation prohibits micro motion. The materials used for the implants have been tested for biocompatibility according to the ISO standard 10993.
• Minimally invasive anterior approach which allows reduced hospital stay and improves rehabilitation
• Tested up to 40 million cycles
• ESP should give a significant reduction in pain severity, re-establish lumbar curvature and natural disc functions
• ESP allows quick return to normal daily activities