Disc herniation caused by a viscoelastic nucleus after total lumbar disc replacement-a case report

Area of Science:

• Orthopedics
• Neurosurgery
• Spinal Surgery

Background:

• Degenerative disc disease (DDD) is a common condition often treated with spinal fusion.
• Total disc replacement (TDR) offers an alternative surgical option for select DDD patients.
• Limited data exists on long-term outcomes and hardware-related adverse events of TDR devices.

Observation:

• A 34-year-old male with prior L5/S1 TDR presented with acute S1 radiculopathy.
• Imaging revealed an intraspinal mass compressing the S1 nerve root.
• Intraoperative findings identified the mass as a migrated viscoelastic nucleus from the TDR prosthesis.

Findings:

• The migrated disc nucleus was surgically removed.
• The patient subsequently underwent interbody fusion and posterior instrumentation.
• Two years post-operatively, the patient developed adjacent segment disease and facet syndromes.

Implications:

• This case highlights an unreported complication of TDR with a viscoelastic device.
• Spine surgeons need to be aware of potential device-specific failure modes in TDR.
• Further research on the long-term safety and complications of TDR devices is warranted.