Abstract：
OBJECTIVE: To describe modes of failure of cervical TDR, their related treatment strategies, and to describe a management strategy for the treatment of failed cervical TDR.
METHODS: This retrospective study was based on a consecutive series of 53 cervical TDR patients who underwent removal or revision surgery. Chart review was conducted to collect general descriptive data, reasons for TDR removal/revision, duration from index implantation to re-operation, and the subsequent procedure performed.
RESULTS: Among 53 patients, 36 underwent TDR removal and fusion, 16 underwent TDR removal and replacement with another TDR, and one patient\'s TDR was revised by repositioning. The mean duration from index surgery to removal/revision was 40.1 months (range: 3 days-222 months). In all cases, removal/revision surgery was completed without complication. The most common reason for removal was severe osteolysis, often involving C. acnes infection, and was primarily associated with one implant type. TDR removal and fusion were performed for subsidence, device migration, treatment of symptoms arising from posterior anatomy (facet joints, etc.), approach-related complications and pain. TDR replacement was feasible for hypermobility, metal allergy, implant locked in kyphosis, and oversized implant use. In one case of TDR malpositioning, the device was successfully revised into appropriate position.
CONCLUSIONS: After cervical TDR failure, replacing a TDR with another implant can be feasible. Reasons for revision or removal after cervical TDR surgery include biomechanical failure, implant migration, surgeon or technical error, or biological reasons. The type of failure can help the surgeon create a strategy to address these complications.
METHODS: This retrospective study was based on a consecutive series of 53 cervical TDR patients who underwent removal or revision surgery. Chart review was conducted to collect general descriptive data, reasons for TDR removal/revision, duration from index implantation to re-operation, and the subsequent procedure performed.
RESULTS: Among 53 patients, 36 underwent TDR removal and fusion, 16 underwent TDR removal and replacement with another TDR, and one patient\'s TDR was revised by repositioning. The mean duration from index surgery to removal/revision was 40.1 months (range: 3 days-222 months). In all cases, removal/revision surgery was completed without complication. The most common reason for removal was severe osteolysis, often involving C. acnes infection, and was primarily associated with one implant type. TDR removal and fusion were performed for subsidence, device migration, treatment of symptoms arising from posterior anatomy (facet joints, etc.), approach-related complications and pain. TDR replacement was feasible for hypermobility, metal allergy, implant locked in kyphosis, and oversized implant use. In one case of TDR malpositioning, the device was successfully revised into appropriate position.
CONCLUSIONS: After cervical TDR failure, replacing a TDR with another implant can be feasible. Reasons for revision or removal after cervical TDR surgery include biomechanical failure, implant migration, surgeon or technical error, or biological reasons. The type of failure can help the surgeon create a strategy to address these complications.
摘要：
目的：描述宫颈TDR的失效模式，他们的相关治疗策略，并描述宫颈TDR失败的治疗策略。
方法：这项回顾性研究是基于连续的53例宫颈TDR患者进行摘除或翻修手术。进行图表审查以收集一般描述性数据，TDR删除/修订的原因，从索引植入到再次手术的持续时间，以及执行的后续过程。
结果：在53例患者中，36例接受了TDR切除和融合，16接受了TDR移除和更换为另一个TDR，一名患者的TDR通过重新定位进行了修订。从索引手术到切除/翻修的平均持续时间为40.1个月（范围：3天-222个月）。在所有情况下,切除/翻修手术完成,无并发症.移除的最常见原因是严重的骨质溶解，通常涉及痤疮梭菌感染，主要与一种植入物类型有关。对沉降进行TDR去除和融合，设备迁移,治疗后解剖引起的症状(小关节，等。),方法相关的并发症和疼痛。TDR替换对于高移动性是可行的，金属过敏,植入物锁定在后凸畸形中，和超大的植入物使用。在一个TDR错位的案例中，该设备已成功修改到适当的位置。
结论：宫颈TDR衰竭后，用另一个植入物替换TDR是可行的。宫颈TDR手术后翻修或切除的原因包括生物力学失败，植入物迁移，外科医生或技术错误，或生物学原因。失败的类型可以帮助外科医生创建解决这些并发症的策略。
方法：这项回顾性研究是基于连续的53例宫颈TDR患者进行摘除或翻修手术。进行图表审查以收集一般描述性数据，TDR删除/修订的原因，从索引植入到再次手术的持续时间，以及执行的后续过程。
结果：在53例患者中，36例接受了TDR切除和融合，16接受了TDR移除和更换为另一个TDR，一名患者的TDR通过重新定位进行了修订。从索引手术到切除/翻修的平均持续时间为40.1个月（范围：3天-222个月）。在所有情况下,切除/翻修手术完成,无并发症.移除的最常见原因是严重的骨质溶解，通常涉及痤疮梭菌感染，主要与一种植入物类型有关。对沉降进行TDR去除和融合，设备迁移,治疗后解剖引起的症状(小关节，等。),方法相关的并发症和疼痛。TDR替换对于高移动性是可行的，金属过敏,植入物锁定在后凸畸形中，和超大的植入物使用。在一个TDR错位的案例中，该设备已成功修改到适当的位置。
结论：宫颈TDR衰竭后，用另一个植入物替换TDR是可行的。宫颈TDR手术后翻修或切除的原因包括生物力学失败，植入物迁移，外科医生或技术错误，或生物学原因。失败的类型可以帮助外科医生创建解决这些并发症的策略。
