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Summary

Cobalt-chrome spheres implanted for degenerative disc disease can subside, causing pain and requiring revision surgery. Revision surgery, including sphere removal and spinal fusion, led to improved outcomes in four patients.

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Area of Science:

Spinal Surgery
Biomaterials Science
Orthopedic Surgery

Background:

Vitallium and stainless steel spheres were previously used for degenerative disc disease but led to subsidence and were abandoned.
Cobalt-chrome spheres were recently reintroduced for intervertebral disc implantation.
Historical attempts to preserve disc height with sphere implantation faced challenges due to subsidence.

Observation:

Four patients experienced low back and/or lower extremity pain and weakness after cobalt-chrome sphere implantation.
Imaging revealed disc space height loss and sphere subsidence in all four patients.
Symptoms were a direct result of sphere subsidence into the vertebral endplates.

Findings:

Three patients underwent successful sphere removal, anterior interbody fusion, and posterior fixation.
One patient with severe subsidence required posterior fusion without sphere removal.
All patients reported improved outcomes 10 months to 3 years post-revision surgery.

Implications:

Cobalt-chrome spheres can cause complications like subsidence, necessitating revision surgery.
Effective surgical strategies exist for managing cobalt-chrome sphere subsidence.
This study highlights the importance of addressing complications associated with resurrected spinal implant technologies.