Myelopathy after cervical disc arthroplasty due to progression of spondylosis at the index level: case report

2018 ◽  
Vol 28 (5) ◽  
pp. 467-471
Author(s):  
Anita Bhansali ◽  
Michael Musacchio ◽  
Noam Stadlan
Keyword(s):  
Case Report ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Artificial Disc ◽  
Rare Occurrence ◽  
Disc Disease ◽  
Disc Arthroplasty ◽  
Low Incidence ◽  
Index Level ◽  
Better Than

Cervical disc arthroplasty (CDA) has emerged as a popular alternative to anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disc disease. CDA has been well studied, with efficacy reported to be equivalent to or better than that seen with ACDF, and it is associated with a consistently low incidence of adverse events. The development or progression of myelopathy after CDA is a particularly rare occurrence. In this report, the authors describe the first known case of recurrence of myelopathy at the index level of surgery after CDA implantation due the continuation of the spondylitic process after placement of the artificial disc.

Heterotopic ossification and radiographic adjacent-segment disease after cervical disc arthroplasty

2019 ◽  
Vol 31 (5) ◽  
pp. 660-669 ◽  
Author(s):  
Michael M. H. Yang ◽  
Won Hyung A. Ryu ◽  
Steven Casha ◽  
Stephan DuPlessis ◽  
W. Bradley Jacobs ◽  
...  
Keyword(s):  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Low Grade ◽  
High Grade ◽  
Artificial Disc ◽  
Disc Arthroplasty ◽  
The Mean ◽  
Index Level

OBJECTIVECervical disc arthroplasty (CDA) is an accepted motion-sparing technique associated with favorable patient outcomes. However, heterotopic ossification (HO) and adjacent-segment degeneration are poorly understood adverse events that can be observed after CDA. The purpose of this study was to retrospectively examine 1) the effect of the residual exposed endplate (REE) on HO, and 2) identify risk factors predicting radiographic adjacent-segment disease (rASD) in a consecutive cohort of CDA patients.METHODSA retrospective cohort study was performed on consecutive adult patients (≥ 18 years) who underwent 1- or 2-level CDA at the University of Calgary between 2002 and 2015 with > 1-year follow-up. REE was calculated by subtracting the anteroposterior (AP) diameter of the arthroplasty device from the native AP endplate diameter measured on lateral radiographs. HO was graded using the McAfee classification (low grade, 0–2; high grade, 3 and 4). Change in AP endplate diameter over time was measured at the index and adjacent levels to indicate progressive rASD.RESULTSForty-five patients (58 levels) underwent CDA during the study period. The mean age was 46 years (SD 10 years). Twenty-six patients (58%) were male. The median follow-up was 29 months (IQR 42 months). Thirty-three patients (73%) underwent 1-level CDA. High-grade HO developed at 19 levels (33%). The mean REE was 2.4 mm in the high-grade HO group and 1.6 mm in the low-grade HO group (p = 0.02). On multivariable analysis, patients with REE > 2 mm had a 4.5-times-higher odds of developing high-grade HO (p = 0.02) than patients with REE ≤ 2 mm. No significant relationship was observed between the type of artificial disc and the development of high-grade HO (p = 0.1). RASD was more likely to develop in the lower cervical spine (p = 0.001) and increased with time (p < 0.001). The presence of an artificial disc was highly protective against degenerative changes at the index level of operation (p < 0.001) but did not influence degeneration in the adjacent segments.CONCLUSIONSIn patients undergoing CDA, high-grade HO was predicted by REE. Therefore, maximizing the implant-endplate interface may help to reduce high-grade HO and preserve motion. RASD increases in an obligatory manner following CDA and is highly linked to specific levels (e.g., C6–7) rather than the presence or absence of an adjacent arthroplasty device. The presence of an artificial disc is, however, protective against further degenerative change at the index level of operation.

scholarly journals Spontaneous Fusion After Cervical Disc Arthroplasty: A Case Report and Literature Review

2020 ◽  
Vol Volume 13 ◽  
pp. 771-776
Author(s):  
Chao-Yuan Ge ◽  
Jing Wang ◽  
Bin-Fei Zhang ◽  
Hao Hui ◽  
Le-Qun Shan ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty

scholarly journals Stepwise illustration of teeth-fixation semi-constrained cervical disc arthroplasty

2017 ◽  
Vol 42 (videosuppl1) ◽  
pp. V4 ◽  
Author(s):  
Chih-Chang Chang ◽  
Jau-Ching Wu ◽  
Peng-Yuan Chang ◽  
Mei-Yin Yeh ◽  
Yi-Hsuan Kuo ◽  
...  
Keyword(s):  
Large Scale ◽  
Primary Stability ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Artificial Disc ◽  
Joint Function ◽  
Disc Arthroplasty ◽  
The Us ◽  
Randomized Control

There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market.The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4–5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level.The video can be found here: https://youtu.be/4DSES1xgvQU.

scholarly journals Metallosis after traumatic loosening of Bryan cervical disc arthroplasty: a case report and literature review

2017 ◽  
Vol 27 (S3) ◽  
pp. 415-420 ◽  
Author(s):  
Chih-Chan Yang ◽  
Chien-Lun Tang ◽  
Chung-Yuh Tzeng ◽  
Hsi-Kai Tsou
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty

Cervical disc arthroplasty for less-mobile discs

2019 ◽  
Vol 31 (3) ◽  
pp. 310-316 ◽  
Author(s):  
Tsung-Hsi Tu ◽  
Chu-Yi Lee ◽  
Chao-Hung Kuo ◽  
Jau-Ching Wu ◽  
Hsuan-Kan Chang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Segmental Mobility ◽  
Disc Arthroplasty ◽  
Flexion Extension ◽  
Index Level

OBJECTIVEThe published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°–9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.METHODSA series of consecutive patients who underwent CDA at the level of C5–6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5–6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5–6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.RESULTSA total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.CONCLUSIONSPreoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.

The Effect of T1-Slope in Spinal Parameters After Cervical Disc Arthroplasty

Neurosurgery ◽  
2020 ◽  
Author(s):  
Yi-Hsuan Kuo ◽  
Chao-Hung Kuo ◽  
Hsuan-Kan Chang ◽  
Li-Yu Fay ◽  
Tsung-Hsi Tu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Clinical Outcomes ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Cervical Lordosis ◽  
Segmental Mobility ◽  
Disc Arthroplasty ◽  
T1 Slope ◽  
Index Level ◽  
Cervical Spinal Alignment

Abstract BACKGROUND Although patients with cervical kyphosis are not ideal candidates for cervical disc arthroplasty (CDA), there is a paucity of data on patients with a straight or slightly lordotic neck. OBJECTIVE To correlate cervical lordosis, T1-slope, and clinical outcomes of CDA. METHODS The study retrospectively analyzed 95 patients who underwent 1-level CDA and had 2-yr follow-up. They were divided into a high T1-slope (≥28°) group (HTSG, n = 45) and a low T1-slope (&lt;28°) group (LTSG, n = 50). Cervical spinal alignment parameters, including T1-slope, cervical lordosis (C2-7 Cobb angle), and segmental mobility (range of motion [ROM]) at the indexed level, were compared. The clinical outcomes were also assessed. RESULTS The mean T1-slope was 28.1 ± 7.0°. After CDA, the pre- and postoperative segmental motility remained similar and cervical lordosis was preserved. All the clinical outcomes improved after CDA. The HTSG were similar to the LTSG in age, sex, segmental mobility, and clinical outcomes. However, the HTSG had higher cervical lordosis than the LTSG. Furthermore, the LTSG had increased cervical lordosis (ΔC2-7 Cobb angle), whereas the HTSG had decreased lordosis after CDA. Patients of the LTSG, who had more improvement in cervical lordosis, had a trend toward increasing segmental mobility at the index level (ΔROM) than the HTSG. CONCLUSION In this series, T1-slope correlated well with global cervical lordosis but did not affect the segmental mobility. After CDA, the changes in cervical lordosis correlated with changes in segmental mobility. Therefore, segmental lordosis should be cautiously preserved during CDA as it could determine the mobility of the disc.

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