Perioperative Morbidität bei lumbaler Bandscheibenprothesenimplantation

AIM: For several years now interbody fusion has been the gold standard procedure for treating degenerative disc disease. The problem of adjacent disc degeneration after interbody arthrodesis led to the development of non-fusion techniques. The device which best represents the philosophy of spine arthroplasty is the total lumbar disc replacement (TDR). An analysis of the perioperative morbidity of lumbar disc replacement was carried out in the current study. METHOD: 66 patients underwent lumbar disc replacement between 2001 and 2007. 78 protheses were implanted. Retrospectively patient-related variables (comorbidity, prior surgeries), perioperative blood loss, number and levels operated on, operation duration and technical and general complications were analysed. RESULTS: 54 patients had mono- and 12 patients bisegmental TDR. The mean operation time was 112 minutes with an average blood loss of 560 mL. Neither the type of comorbidity, prior surgery, operation duration, nor level operated on had an influence on the occurrence of perioperative morbidity. A significant influence could be shown for the number of levels operated on and the intraoperative blood loss. General complications were seen in 6 persons (9%) with urinary tract infection, technical complications occurred in 4 persons (6%) with severe blood loss (> 1500 mL) and erythrocyte/plasma substitution, 1 person (1.5%) with an injury of the iliac vein, 1 person (1.5%) with retrograde ejaculation and 1 person (1.5%) with dural tear and consecutive epidural infection. CONCLUSION: In our study the perioperative morbidity of lumbar disc replacement was similar to the data published so far and seems to be comparable with the perioperative morbidity of lumbar interbody fusion.