Removal of the Charité lumbar artificial disc prosthesis: surgical technique

Descriptive study of a surgical technique for removal of the Charité total lumbar disc prosthesis.

To describe the surgical technique to remove total disc prosthesis and the occurrence of complications in disc removal surgery.

As lumbar total disc replacement seems to be more and more an accepted option to treat degenerative disc disease, the more will the need for removal increase in case of failure.

Twenty-nine Charité total disc prostheses were removed in 25 consecutive patients. To avoid mobilization of the adhered great vessels away from the spine, we address L4-L5 (or higher) anterolaterally from the left side, after mobilizing the psoas and exposing the lateral side of the disc level with the prosthesis. The approach to L5-S1 is similar to the implantation of the disc prosthesis. After removal of the prosthesis, the created defect is filled with a bone graft to accomplish an anterior fusion. This retrieval surgery is always combined with a posterior pedicle screw fusion.

In our series, we had 4 intraoperative major vessel lesions without major blood loss; 1 of these cases developed a deep venous thrombosis of the left leg. In 1 case, we encountered a small colon lesion and in 1 patient, a lesion of the ureter resulting in resection of the kidney. In 1 case, we had profound bleeding from the bone beneath an S1 endplate, which resulted in a total blood loss of 5100 mL. In another patient, we planned to remove the disc prosthesis; however, because of rupture of the small intestine only posterior fusion was performed.

Retrieval of a Charité artificial disc prosthesis is feasible, but it has its inherent risks.