Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

OBJECTIVEThe objective of this study was to identify the risk factors of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and the subsequent effect of this phenomenon.METHODSThe authors performed a retrospective radiological review of 185 patients with a minimum 5-year follow-up after CDA (using Bryan, Discocerv, Mobi-C, or Baguera C). Postoperative radiographs were examined and compared to the initial postoperative films to determine the percentage of ABL. The relationship of ABL to potential risk factors was analyzed.RESULTSComplete radiological assessment was available in 145 patients with 193 CDRs and 383 endplates (average age 45 years, range 25–65 years, 54% women). ABL was identified in 63.7% of CDRs (48.7% mild, 11.9% moderate, 3.1% severe). Age (p = 0.770), sex (p = 0.200), postoperative alignment (p = 0.330), midflexion point (p = 0.509), maximal flexion (p = 0.080), and extension (p = 0.717) did not relate to ABL. There was no significant difference in the rate of severe ABL between implants. Multilevel surgery conferred an increased risk of any and severe ABL (p = 0.013 for both). The upper endplate, defined as superior to the CDA, was more commonly involved (p = 0.008), but there was no significant difference whether the endplate was between or not between implants (p = 0.226). The development of ABL did not affect the long-term range of movement (ROM) of the CDA, but did increase the overall risk of autofusion. ABL was not associated with pain or functional deficits. No patients required a reoperation or revision of their implant during the course of this study, and there were no cases of progressive ABL beyond the first year.CONCLUSIONSABL is common in all implant types assessed, although most is mild. Age, sex, postoperative alignment, ROM, and midflexion point do not relate to this phenomenon. However, the greater the number of levels operated, the higher the risk of developing ABL. The development of ABL has no long-term effect on the mechanical functioning of the disc or necessity for revision surgery, although it may increase the rate of autofusion.

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Long-Term Societal Costs of Anterior Cervical Discectomy and Fusion versus Cervical Disc Arthroplasty for the Treatment of Single-Level Cervical Disc Disease

The Spine Journal ◽

10.1016/j.spinee.2014.08.064 ◽

2014 ◽

Vol 14 (11) ◽

pp. S23 ◽

Cited By ~ 1

Author(s):

Ahmer K. Ghori

Keyword(s):

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Cervical Disc Disease ◽

Disc Disease ◽

Societal Costs ◽

Disc Arthroplasty ◽

Cervical Discectomy ◽

Single Level

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Late Implant Failure in Cervical Disc Arthroplasty (M6-C, Spinal Kinetics) Causing Radiculopathy and Myelopathy

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1286-5172 ◽

2020 ◽

Author(s):

Andreas Pingel ◽

Christoph-Heinrich Hoffmann ◽

Matti Scholz ◽

Frank Kandziora

Keyword(s):

Spinal Canal ◽

Clinical Signs ◽

Implant Failure ◽

Posterior Dislocation ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Posterior Portion ◽

Disc Arthroplasty ◽

Core Dislocation

AbstractCervical disc arthroplasty (CDA) is an approved surgical treatment option in selected patients with cervical spinal disc degeneration. Even though CDA is a standard procedure since 20 years, there is a lack of information about long term performance. The published reoperation rates after CDA are low and comparable to anterior cervical fusion. The authors describe a severe failure and dysfunction with a partial core dislocation of a cervical prosthesis into the spinal canal (M6-C, Spinal Kinetics, Sunnyvale, CA, USA). Six years after implantation of a cTDR (cervical Total Disk Replacement) of the M6 type at C4/5 level, a 52 year-old women presented herself with new clinical signs of cervical myelopathy and radicular pain. Complete posterior dislocation of the central core of the implant into the spinal canal was identified as a cause. The failed device was removed completely and an ACCF (anterior cervical corpectomy and fusion) was performed. Intraoperatively, rupture of the posterior portion of the mesh tissue with posterior dislocation of the whole prosthesis core was detected. This is the second described case of a severe implant failure with core dislocation in this type of cTDR device. Even though there are thousands of successful implantations and middle term outcomes, it seems to be necessary to continue with long term radiological follow up to exclude similar failure in this type of prosthesis.

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