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Subsidence and malplacement with the Oblique Maverick Lumbar Disc Arthroplasty: technical note
Laurence A G Marshman1, Tai Friesem, Y Raja Rampersaud
1Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton North Tees, TS19 8PE. l.a.g.marshman@btinternet.com
Background:
The A-Mav (Medtronic, Sofamor Danek, Memphis, TN) is a well-established lumbar total disc arthroplasty device. The O-Mav (Medtronic) is a more recent innovation designed to minimize the potential vascular complications associated with A-Mav insertion at L4/5. No study has hitherto studied the relative accuracy or safety of the two techniques.
Purpose:
To compare the accuracy of lumbar disc arthroplasty placement by using the anterior technique (A-Mav) with the oblique (O-Mav) technique.
Study Design:
Technical report.
Patient Sample:
Fourteen patients.
Outcome Measures:
Implant placement accuracy on high-resolution computed tomography scan. Comparative morbidity, mortality, blood loss, and operating time were also assessed.
Methods:
Patients were considered for lumbar disc arthroplasty who had suffered chronic discogenic low back pain unresponsive to nonoperative management for at least 6 months. All patients were operated on at the L4/5 level. A-Mavs were inserted in 7 patients and O-Mavs in 7. Implant placement was analyzed postoperatively by using computer software on high-resolution computed tomography scan with respect to four parameters: (1) off-center malplacement, (2) axial rotational malplacement, (3) coronal tilt, and (4) vertebral body susbsidence. Comparative morbidity, mortality, blood loss, and operating time were also assessed.
Results:
Subsidence, off-center malplacement, and rotational malplacement were significantly increased in O-Mavs compared with A-Mavs (4.3+/-0.6 mm vs. 1.6+/-0.6 mm, p=.008; 3.1+/-0.4 mm vs. 1.3+/-0.4 mm, p=.006; 6.5 degrees +/-1.2 degrees vs. 3.8 degrees +/-0.4 degrees , p=.046). No significant differences were found between O-Mavs and A-Mavs in tilt, operating time, blood loss, or morbidity and mortality.
Conclusions:
O-Mav insertion appears to be complicated by significantly greater vertebral body subsidence and malplacement than A-Mav insertion. A-Mav insertion therefore appears to be more accurate and less complicated yet equally as safe as O-Mav insertion.
