Cervical instability following artificial disc replacement

Background: Although there has been increased interest in utilizing artificial disc replacement (ADR) techniques to treat cervical degenerative disease, few reports have focused on their postoperative complication and reoperation rates. Case Description: A 52-year-old male underwent the uneventful placement of a C5-C6 cervical ADR for disc disease and foraminal stenosis. One year later, he experienced the onset of severe neck pain attributed to instability of the ADR construct. This required removal of the C5-6 ADR and subsequent fusion. Conclusion: Strict adherence to appropriate criteria is critical for choosing when to place a cervical ADR. This requires documenting; adequate surgical indications, careful selection of the appropriate ADR device, meticulous surgical technique, proper preservation of the supporting structures, and sufficient neural decompression.

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Examination: Artificial disc replacement-Evolutionary treatment for degenerative disc disease

AORN Journal ◽

10.1016/s0001-2092(06)60312-8 ◽

2005 ◽

Vol 82 (2) ◽

pp. 207-210

Keyword(s):

Degenerative Disc Disease ◽

Disc Replacement ◽

Artificial Disc ◽

Disc Disease ◽

Degenerative Disc ◽

Artificial Disc Replacement

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Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes

Journal of Neurosurgery Spine ◽

10.3171/2018.9.spine18659 ◽

2019 ◽

Vol 30 (3) ◽

pp. 323-331 ◽

Cited By ~ 6

Author(s):

Anna MacDowall ◽

Nuno Canto Moreira ◽

Catarina Marques ◽

Martin Skeppholm ◽

Lars Lindhagen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Outcome Measures ◽

Degenerative Disc Disease ◽

Controlled Trial ◽

Disc Replacement ◽

Artificial Disc ◽

Disc Disease ◽

Fusion Surgery ◽

Randomized Controlled ◽

Artificial Disc Replacement

OBJECTIVEThe method of artificial disc replacement (ADR) has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease (DDD) with radiculopathy. Preserving the motion of ADR devices aims to prevent immobilization side effects such as adjacent-segment pathology (ASP). However, long-term follow-up evaluations using MRI are needed to investigate if this intent is achieved.METHODSThe authors performed a randomized controlled trial with 153 patients (mean age 47 years) undergoing surgery for cervical radiculopathy. Eighty-three patients received an ADR and 70 patients underwent fusion surgery. Outcomes after 5 years were assessed using patient-reported outcome measures using the Neck Disability Index (NDI) score as the primary outcome; motion preservation and heterotopic ossification by radiography; ASP by MRI; and secondary surgical procedures.RESULTSScores on the NDI were approximately halved in both groups: the mean score after 5 years was 36 (95% confidence interval [CI] 31–41) in the ADR group and 32 (95% CI 27–38) in the fusion group (p = 0.48). There were no other significant differences between the groups in six other patient-related outcome measures. Fifty-four percent of the patients in the ADR group preserved motion at the operated cervical level and 25% of the ADRs were spontaneously fused. Seventeen ADR patients (21%) and 7 fusion patients (10%) underwent secondary surgery (p = 0.11), with 5 patients in each group due to clinical ASP.CONCLUSIONSIn patients with cervical DDD and radiculopathy decompression as well as ADR, surgery did not result in better clinical or radiological outcomes after 5 years compared with decompression and fusion surgery.Clinical trial registration no.: 44347115 (ISRCTN).

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