Acquired spondylolysis after implantation of a lumbar ProDisc II prosthesis: case report and review of the literature

Abstract

Study design: A case of acquired lumbar spondylolysis following lumbar disc arthroplasty L5-S1 in an 40-year-old woman and review of the literature.

Objectives: To present and discuss a case of acquired lumbar spondylolysis after implantation of an artificial disc L5-S1 that may have impaired a good clinical result requiring additional posterior lumbar instrumentation and fusion in order to improve understanding of this condition and to propose an effective method of surgical management.

Summary of background data: Lumbar disc arthroplasty is a possible surgical option for patients with degenerative disc disease. Acquired spondylolysis is a rare but known complication of spinal fusion but has never been described as a consequence of mobile disc arthroplasty. The authors present the first case in the literature who developed this complication.

Methods: A 40-year-old woman with severe osteochondrosis L5-S1 and discogenic lumbar back pain underwent implantation of an artificial disc. Surgery and postoperative course were uneventful and the patient improved significantly as for back pain and mobility. Eighteen months after surgery, the patient was again admitted to our outpatient clinic for back pain that had slowly increased over time.

Results: The radiologic workup showed a new spondylolysis L5 without a spondylolisthesis. Because of unsuccessful conservative treatment, the patient underwent posterior lumbar instrumentation and fusion L5-S1, leading to a significant pain reduction and a good clinical outcome.

Conclusion: Spine surgeons should be aware of the possibility of lumbar disc arthroplasty to induce acquired spondylolysis impairing good clinical results.