Late complication of cervical disc arthroplasty: heterotopic ossification causing myelopathy after 10 years. Illustrative case

BACKGROUND Heterotopic ossification (HO) is a well-documented complication of cervical disc arthroplasty (CDA), although it rarely causes adverse clinical effects. Despite high-grade HO possibly limiting segmental mobility, it is reportedly seldom associated with symptoms. OBSERVATIONS The authors report a case of a 46-year-old male patient who underwent hybrid CDA and anterior cervical discectomy and fusion for 3-level cervical disc herniation that caused myeloradiculopathy. The surgery was successful; the patient experienced nearly complete recovery postoperatively. The follow-up images, including computed tomography and magnetic resonance imaging scans, showed satisfactory decompression at the indexed levels without residual osteophytes or ossification of the posterior longitudinal ligament. However, 10 years later, the patient presented with symptomatic compressive myelopathy caused by severe HO that prompted a secondary surgery. LESSONS Although it is generally reported in the literature that HO is clinically innocuous, in this patient, it gradually and progressively developed and caused myelopathy, requiring a secondary surgery. Symptomatic HO can be expected over time, and patients with a high risk of HO deserve long-term follow-up after CDA. Further investigations are warranted to corroborate these risk factors, including multilevel calcified disc herniation, severe spondylosis, and suboptimal placement of the device during primary CDA surgery.

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Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine141217 ◽

2016 ◽

Vol 24 (5) ◽

pp. 752-759 ◽

Cited By ~ 14

Author(s):

Peng-Yuan Chang ◽

Hsuan-Kan Chang ◽

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

Li-Yu Fay ◽

...

Keyword(s):

Cervical Spine ◽

Heterotopic Ossification ◽

Clinical Outcomes ◽

Large Scale ◽

Japanese Orthopaedic Association ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

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Cervical disc arthroplasty at C2–3: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21320 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Jason Ku ◽

Johnson Ku ◽

Hsuan-Kan Chang ◽

Jau-Ching Wu

Keyword(s):

Disc Herniation ◽

Magnetic Resonance Images ◽

Disc Replacement ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Illustrative Case ◽

Viable Option ◽

Disc Disease ◽

Disc Arthroplasty ◽

Arm Pain

BACKGROUND Since the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation. OBSERVATIONS In this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level. LESSONS To date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.

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