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Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty
Keith L Jackson1, Justin M Hire1, Jeremy M Jacobs1
1Department of Orthopaedics and Rehabilitation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
Asian Spine Journal
|June 23, 2015
Summary
Heterotopic ossification (HO) in the spinal canal is a rare complication after lumbar total disc arthroplasty (TDA). This case highlights a novel HO pattern causing radiculopathy, necessitating surgical intervention and a modified classification system.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Lumbar total disc arthroplasty (TDA) is a treatment for discogenic back pain.
- Heterotopic ossification (HO) is abnormal bone formation, typically extra-spinal.
- Radiculopathy secondary to spinal HO after TDA has not been previously reported.
Purpose of the Study:
- To report a novel case of radiculopathy caused by spinal HO after lumbar TDA.
- To propose a modification to the McAfee classification of HO.
- To emphasize the importance of intraoperative component positioning in TDA.
Main Methods:
- Case report of a patient who underwent L5/S1 lumbar TDA.
- Diagnostic workup including radiographs and CT myelogram.
- Revision surgery involving implant removal, anterior lumbar interbody fusion, posterior decompression, and pedicle screw fixation.
Main Results:
- The patient developed atraumatic radiculopathy two years post-TDA.
- CT myelogram revealed posterior implant malposition with intraspinal HO impinging a nerve root.
- Revision surgery resulted in complete resolution of radicular pain and solid fusion at two-year follow-up.
- No recurrence of HO was observed.
Conclusions:
- Spinal HO can occur after lumbar TDA, leading to radiculopathy and implant failure.
- A modified McAfee classification (Class V and VI) is proposed for HO following TDA.
- Meticulous intraoperative component placement is crucial to prevent this complication.