Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/358
Title: Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: Report of 2 cases.
Epworth Authors: Claydon, Matthew
Malham, Gregory
Other Authors: Gragnaniello, Cristian
Seex, Kevin
Eisermann, Lukas
Keywords: Department of Vascular Surgery, Epworth Hospital, Melbourne, Victoria, Australia
Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Anterior Dislocation
Maverick Lumbar Disc Prosthesis
Early Postoperative Period
Translation Forces
Lumbar Vertebrae Surgery
Intervertebral Disc Surgery
Postoperative Complications
Prostheses and Implants
Total Disc Replacement
Disc Arthroplasty
Issue Date: Aug-2013
Publisher: The American Association of Neurological Surgeons
Citation: J Neurosurg Spine. 2013 Aug;19(2):191-6.
Abstract: The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported. The anterior Maverick device has a ball-and-socket design made of cobalt-chromium-molybdenum metal plates covered with hydroxyapatite. The superior and inferior endplates have keels to resist translation forces. The patient in Case 1 was a 52-year-old man with severe L4-5 discogenic pain; and in Case 2, a 42-year-old woman with disabling L4-5 and L5-S1 discogenic back pain. Both patients were without medical comorbidities and were nonsmokers with no risk factors for osteoporosis. Both had undergone uneventful retroperitoneal approaches performed by a vascular access surgeon. Computed tomography studies on postoperative Day 2 confirmed excellent prosthesis placement. Initial recoveries were uneventful. Two weeks postoperatively, after stretching (extension or hyperextension) in bed at home, each patient suffered the sudden onset of severe abdominal pain with anterior dislocation of the Maverick prosthesis. The patients were returned to the operating room and underwent surgery performed by the same spinal and vascular surgeons. Removal of the Maverick prosthesis and anterior interbody fusion with a separate cage and plate were performed. Both patients had recovered well with good clinical and radiological recovery at the 6- and 12-month follow-ups. Possible causes of the anterior dislocation of the Maverick prosthesis include the following: 1) surgeon error: In both cases the keel cuts were neat, and early postoperative CT confirmed good placement of the prosthesis; 2) equipment problem: The keel cuts may have been too large because the cutters were worn, which led to an inadequate press fit of the implants; 3) prosthesis fault: Both plates of the dislocated implants looked normal and manufacturer analysis reported no fault; 4) patient factors: Both dislocations happened early in the postoperative period, after hyperextension of the spine while the patient was supine in bed. Bracing would not have reduced hyperextension. Dislocation of a lumbar spinal implant represents a life-threatening complication and should therefore be considered and recognized early. Radiographic and CT studies of both the lumbar spine (for prosthesis) and the abdomen (for hematoma) should be performed, as should CT angiography (for vessel damage or occlusion). Any anterior lumbar revision surgery is hazardous, and it is strongly advisable to have a vascular surgeon scrubbed. In cases of dislocation or extrusion of a lumbar interbody prosthesis, the salvage revision strategy is fusing the segment via the same anterior approach. Surgeons should be aware of the risk of anterior dislocation of the Maverick prosthesis. Keel cutters should be regularly checked for sharpness, as they may be implicated in the loosening of implants. Patients and their physical therapists should also avoid lumbar hyperextension in the early postoperative period.
URI: http://hdl.handle.net/11434/358
DOI: 10.3171/2013.5.SPINE12753
PubMed URL: http://www.ncbi.nlm.nih.gov/pubmed/23768025
ISSN: 0022-3085
1933-0693
Journal Title: Journal of Neurosurgery
Type: Journal Article
Affiliated Organisations: Department of Neurosurgery, Macquarie University, Sydney, New South Wales, Australia
Type of Clinical Study or Trial: Case reports
Appears in Collections:Neurosciences
Musculoskeletal

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