Revisions of Artificial Disc Replacement (ADR) Devices

[sportsnut3007]

In terms of revisions of lateral adrs, is it possible to pull them out and then put a new one in if first one fails, etc? Also, with the new ones like Freedom And Spinal kinetics, will revision even be possible or basically these better not fail or ever break down. I know revision for even the pro disc and maverick is a hell of a procedure as mark went through, but was possible. I would assume only hope for revisioin of freedom is anterior with alot of bone removal? Also, does anyone think the new ones with no keels (i.e. ranier and 3df later)would be able to be replaced with other ones with no keels? Or does the attachment fuse to the bone somehow and revision is still as dangerous as ones with keels?

[Justin]

In terms of revisions of lateral adrs, is it possible to pull them out and then put a new one in if first one fails, etc? Also, with the new ones like Freedom And Spinal kinetics, will revision even be possible or basically these better not fail or ever break down. I know revision for even the pro disc and maverick is a hell of a procedure as mark went through, but was possible. I would assume only hope for revisioin of freedom is anterior with alot of bone removal? Also, does anyone think the new ones with no keels (i.e. ranier and 3df later)would be able to be replaced with other ones with no keels? Or does the attachment fuse to the bone somehow and revision is still as dangerous as ones with keels?

In my opinion, any revision / explantation of an artificial disc replacement device is an extremely challenging (technically difficult) procedure. The explantation of keeled-devices is more challenging than non-keeled devices. However, with any artificial disc replacement device that is placed, there will inherently be remodeling of bone ("osteointegration") on the adjacent vertebral bodies. Osteointegration of an artificial disc replacement device to the adjacent vertebral endplates will demonstrate changes upon removal, as the bone that has "grown into" (or adhered) to the device will have to be "fractured" so that the device can be explanted. Before a new device is placed (if one is to be placed), the vertebral endplates will have to be "prepped" (think smooth, level surface) resulting in loss of bone.

Lateral explantation of an artificial disc replacement device has more favorable outcomes, whereas an anterior explantation significantly increases the risk of injury due to the scaring of the descending aorta and inferior vena cava from the initial anterior approach. This is not to say that lateral explanation is without risks. I have spoken with Spine Patients that almost died after lateral and anterior explantation approaches.

At the end of the day, think of an artificial disc as part of your body once implanted. Personally, I see the only reasons for device explantation are "failure" of the device / migration or subsidence of the device that places the patient at risk of significant future functional impairment, or if the patient is injured traumatically in an accident (where it is deemed necessary for explantation of the device).

Remember, the above is just my personal 2 cents.

[Greg]

Remember, the above is just my personal 2 cents.

You might call that your "2 cents" but you used a lot of big words there buddy That's gotta be worth more than 2 cents. Very informative answer though. I still dont understand how the ADR devices that have no keel attach to the vertebraes and stay in plave without moving.

[Justin]

You might call that your "2 cents" but you used a lot of big words there buddy That's gotta be worth more than 2 cents. Very informative answer though. I still dont understand how the ADR devices that have no keel attach to the vertebraes and stay in plave without moving.

The short of it: ligaments of the spine and gravity.