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Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty.

Jackson KL, Hire JM, Jacobs JM, Key CC, DeVine JG - Asian Spine J (2015)

Bottom Line: His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy.At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone.We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Rehabilitation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.

ABSTRACT
To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO.

No MeSH data available.


Related in: MedlinePlus

Computed tomography myelogram with indications of compression of the traversing nerve root secondary to the inferior endplate of the implant residing posterior to the margin of the vertebral endplate as well as associated posterior bone growth into the canal.
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Figure 2: Computed tomography myelogram with indications of compression of the traversing nerve root secondary to the inferior endplate of the implant residing posterior to the margin of the vertebral endplate as well as associated posterior bone growth into the canal.

Mentions: A physical examination revealed a well-healed abdominal surgical scar, and the lumbar range of motion was limited in forward flexion secondary to right leg pain, with near full motion in all other planes. A straight leg raise reproduced the patient's symptoms, and a neurologic examination revealed 5/5 motor strength in all major muscle groups with intact sensation to light touch in all lower extremity dermatomes. The patellar and achilles reflexes were 2+ and symmetric. On presentation, radiographs demonstrated implant encroachment into the spinal canal with heterotopic bone formation outside the margins of the disc (Fig. 1). A computed tomography myelogram (Fig. 2) revealed compression of the traversing nerve root secondary to the inferior endplate of the implant that resided posterior to the margin of the vertebral endplate as well as an associated posterior bone growth further into the canal.


Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty.

Jackson KL, Hire JM, Jacobs JM, Key CC, DeVine JG - Asian Spine J (2015)

Computed tomography myelogram with indications of compression of the traversing nerve root secondary to the inferior endplate of the implant residing posterior to the margin of the vertebral endplate as well as associated posterior bone growth into the canal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4472597&req=5

Figure 2: Computed tomography myelogram with indications of compression of the traversing nerve root secondary to the inferior endplate of the implant residing posterior to the margin of the vertebral endplate as well as associated posterior bone growth into the canal.
Mentions: A physical examination revealed a well-healed abdominal surgical scar, and the lumbar range of motion was limited in forward flexion secondary to right leg pain, with near full motion in all other planes. A straight leg raise reproduced the patient's symptoms, and a neurologic examination revealed 5/5 motor strength in all major muscle groups with intact sensation to light touch in all lower extremity dermatomes. The patellar and achilles reflexes were 2+ and symmetric. On presentation, radiographs demonstrated implant encroachment into the spinal canal with heterotopic bone formation outside the margins of the disc (Fig. 1). A computed tomography myelogram (Fig. 2) revealed compression of the traversing nerve root secondary to the inferior endplate of the implant that resided posterior to the margin of the vertebral endplate as well as an associated posterior bone growth further into the canal.

Bottom Line: His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy.At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone.We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Rehabilitation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.

ABSTRACT
To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO.

No MeSH data available.


Related in: MedlinePlus