Posterior intraprosthetic dislocation of cervical arthroplasty: illustrative case

BACKGROUND Cervical disc herniation is a common condition usually treated with anterior cervical discectomy and fusion (ACDF) or, more recently, with cervical disc arthroplasty (CDA). Both treatments offer similar clinical results. However, CDA has been found to offer fewer medium- to long-term complications as well as potential reduction of long-term adjacent disc degeneration. OBSERVATIONS A 40-year-old man was treated with cervical discectomy and arthroplasty due to a C6–C7 disc herniation with left C7 radiculopathy. After the treatment, his postoperative follow-up appointments were uneventful for 9 months. However, after 9 months, he reported cervical pain and a right C7 radiculopathy after neck extension. Imaging confirmed a posterior intraprosthetic dislocation, the first case reported to date. The patient was received emergency surgery under neuromonitoring, and the prosthesis was replaced by an ACDF and anterior plate. The insert presented a rupture of the anterior horn. The patient presented no preoperative or postoperative neurological deficit, and his follow-up review revealed no issues. LESSONS Posterior intraprosthetic dislocation is an extremely rare complication. It may occur with Mobi-C cervical arthroplasty in the case of rupture and oxidation of the polyethylene insert. Spine surgeons should be aware of this potential major complication.

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P182 Long-term follow up of patients with myotomal muscle weakness due to cervical disc herniation

Clinical Neurophysiology ◽

10.1016/s1388-2457(08)60453-8 ◽

2008 ◽

Vol 119 ◽

pp. S117

Author(s):

Cengiz Bahadir ◽

Burcu Önal ◽

Feride Ocak ◽

Vildan Yaman ◽

Semra Bozkurt

Keyword(s):

Muscle Weakness ◽

Disc Herniation ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Long Term Follow Up ◽

Myotomal Muscle

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Long-Term Results of Multiple Anterior Cervical Discectomy with Cage Fusion Technique: Results of Multiple Centre Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.631 ◽

2019 ◽

Vol 7 (17) ◽

pp. 2824-2828 ◽

Cited By ~ 1

Author(s):

Hamdi Mostafa ◽

Mohsen Lotfi ◽

M. Wahid

Keyword(s):

Neck Pain ◽

Anterior Cervical Discectomy ◽

Long Term Results ◽

Cervical Disc ◽

Fusion Technique ◽

Cervical Discectomy ◽

Cage Subsidence ◽

Long Term Follow Up

BACKGROUND: Cervical herniation is commonly treated by anterior cervical discectomy and fusion (ACDF) if conservative management has failed in relief of the patient's symptoms. Disc fusion is needed after ACDF as anterior longitudinal ligament will be absent after doing the operation, especially if multiple levels are needed. The occurrence of complications as cage subsidence and adjacent segment failure related to the length of follow up as they are increasing in percentage is directly proportional to the length of follow up. AIM: Analysis of the results for patients who underwent 3 levels of ACDF with cage fusion for short term and long term follow up in multiple centres as the visual analogue score for neck pain & brachialgia. METHODS: This retrospective cohort series of 68 patients selected out of 136 patients suffering from 3 levels of degenerative cervical disc disease who were unresponsive to adequate conservative therapy. All cases were treated at one of the neurosurgery departments of 3 different hospitals (Naser institute for research and treatment hospital, Haram hospital for research and treatment and Misr university for science and technology) by the same surgical team in the period from February 2012 to February 2017. RESULTS: We found in this study;68 patients fulfilling the inclusion criteria, of the 29 patients underwent 3 levels of ACDF starting from C3-4 (42.65%) and 39 patients who underwent 3 levels of ACDF starting from C4-5 (57.35%). Clinical assessment for VAS pain score for both neck pain and radiculopathy were done before the surgery and immediately post-operative and during each time follow up visit and we found statistically significant immediate postoperative improvement. (P ˂ 0.05) CONCLUSION: Stand-alone three levels of an anterior cervical discectomy with cage fusion technique improved the clinical outcomes on long term follow up.

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Percutaneous endoscopic cervical discectomy for ruptured cervical disc herniation: clinical results and radiological analysis at a minimum 2 years follow-up

ArgoSpine News & Journal ◽

10.1007/s12240-010-0040-0 ◽

2010 ◽

Vol 22 (3) ◽

pp. 113-117

Author(s):

Sung Min Hur ◽

Sang-Ho Lee ◽

Won-Chul Choi ◽

Youngshin Rho

Keyword(s):

Disc Herniation ◽

Clinical Results ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Radiological Analysis

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Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up

Journal of Neurosurgery Spine ◽

10.3171/2011.10.spine11497 ◽

2012 ◽

Vol 16 (2) ◽

pp. 163-171 ◽

Cited By ~ 41

Author(s):

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

Tsung-Hsi Tu ◽

Hsiao-Wen Tsai ◽

Chin-Chu Ko ◽

...

Keyword(s):

Heterotopic Ossification ◽

Clinical Outcomes ◽

Disc Herniation ◽

Cervical Disc ◽

Artificial Disc ◽

Cervical Arthroplasty ◽

Single Level ◽

Arm Pain ◽

Estimated Blood Loss

Object Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty. Methods Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months. Results Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in both groups remained mobile (100% and 95.8%, p = 0.408). The clinical outcomes were not significantly different between the groups at all postoperative time points of evaluation, and clinical improvements were also similar. Conclusions Clinical outcomes of single-level cervical arthroplasty for soft-disc herniation and spondylosis were similar 3 years after surgery. There was a significantly higher rate of HO formation in patients with spondylosis than in those with a soft-disc herniation. The mobility of the artificial disc is maintained, but the long-term effects of HO and its higher frequency in spondylotic cases warrant further investigation.

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Clinical outcome following anterior cervical discectomy and fusion with and without anterior cervical plating for the treatment of cervical disc herniation—a 25-year follow-up study

Neurosurgical Review ◽

10.1007/s10143-017-0872-6 ◽

2017 ◽

Vol 41 (2) ◽

pp. 473-482 ◽

Cited By ~ 14

Author(s):

Benedikt W. Burkhardt ◽

Moritz Brielmaier ◽

Karsten Schwerdtfeger ◽

Joachim M. Oertel

Keyword(s):

Clinical Outcome ◽

Disc Herniation ◽

Anterior Cervical Discectomy ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Follow Up Study ◽

Cervical Plating

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Implantation of an empty carbon fiber composite frame cage after single-level anterior cervical discectomy in the treatment of cervical disc herniation: preliminary results

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.98.2.0143 ◽

2003 ◽

Vol 98 (2) ◽

pp. 143-147 ◽

Cited By ~ 6

Author(s):

Michael Payer ◽

Daniel May ◽

Alain Reverdin ◽

Enrico Tessitore

Keyword(s):

Disc Herniation ◽

Fiber Composite ◽

Anterior Cervical Discectomy ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Carbon Fiber Composite ◽

Content Type ◽

Cervical Discectomy ◽

Fine Print

Object. The authors sought to evaluate retrospectively the radiological and clinical outcome of anterior cervical discectomy followed by implantation of an empty carbon fiber composite frame cage (CFCF) in the treatment of patients with cervical disc herniation and monoradiculopathy. Methods. Twenty-five consecutive patients (12 men, 13 women, mean age 45 years) with monoradiculopathy due to cervical disc herniation were treated by anterior cervical discectomy followed by implantation of an empty CFCF cage. On lateral flexion—extension radiographs segmental stability at a mean follow up of 14 months (range 5–31 months) was demonstrated in all 25 patients, and bone fusion was documented in 24 of 25 patients. The mean anterior intervertebral body height was 3.4 mm preoperatively and 3.8 mm at follow up in 20 patients. In these patients the mean segmental angle (angle between lower endplate of lower and upper vertebra) was 0.9° preoperatively and 3.1° at follow up. In the remaining five patients preoperative images were not retrievable. Self-scored neck pain based on a visual analog scale (1, minimum; 10, maximum) changed from a preoperative average of 5.6 to an average of 2 at follow up; radicular pain was reduced from 7.7 to 2.1 postoperatively. Analysis of the SF12 questionnaires showed a significant improvement in both the physical capacity score (preoperative mean 32.4 points; follow up 46 points) and the mental capacity score (preoperative mean 45.8 points; follow up 57.5 points). Conclusions. Implantation of an empty CFCF cage in the treatment of cervical disc herniation and monoradiculopathy avoids donor site morbidity associated with autologous bone grafting as well as the use of any supplementary material inside the cage. Restoration or maintenance of intervertebral height and thus segmental lordosis and a very high rate of segmental stability and fusion are achieved using this technique.

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Cervical disc prosthesis: 2-year follow-up

Coluna/Columna ◽

10.1590/s1808-185120151402113265 ◽

2015 ◽

Vol 14 (2) ◽

pp. 85-87

Author(s):

Romero Pinto de Oliveira Bilhar ◽

Alexandre Fogaça Cristante ◽

Raphael Martus Marcon ◽

Ivan Dias da Rocha ◽

Olavo Biraghi Letaif ◽

...

Keyword(s):

Medical Records ◽

Epidemiological Data ◽

Cervical Disc ◽

Safe Procedure ◽

Disc Prosthesis ◽

Cervical Arthroplasty ◽

Cervical Disc Prosthesis ◽

The Mean

<sec><title>OBJECTIVE:</title> To review the medical records of patients who underwent surgery for placement of cervical disc prosthesis after two years of postoperative follow-up, showing the basic epidemiological data, the technical aspects and the incidence of complications.</sec><sec><title>METHODS:</title> Medical records of seven patients who underwent surgery for placement of cervical disc prosthesis were reviewed after two years of follow-up, at the Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo.</sec><sec><title>RESULTS:</title> The average age of patients participating in this study was 43.86 years. Six patients (85.7%) had one level approached while one patient (14.3%) had two levels addressed. The level C5-C6 has been approached in one patient (14.3%) while the C6-C7 level was addressed in five patients (71.4%). One patient (14.3%) had these two levels being addressed, C5-C6 and C6-C7. The mean operative time was 164.29±40 minutes. Three patients were hospitalized for 2 days and four for 3 days making an average of 2.57±0.535 days. Two patients (28.6%) underwent a new surgical intervention due to loosening of the prosthesis. The mean follow-up was 28.14±5.178 months (23-35 months).</sec><sec><title>CONCLUSIONS:</title> Although cervical arthroplasty appears to be a safe procedure and present promising results in our study as well as in many other studies, it requires long-term studies.</sec>

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Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e811 ◽

2021 ◽

Vol 24 (6) ◽

pp. E811-E819

Keyword(s):

Clinical Efficacy ◽

Study Design ◽

Disc Herniation ◽

Small Sample ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Disc Protrusion ◽

Average Hospital ◽

Cervical Discectomy

BACKGROUND: Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited. OBJECTIVES: To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application. STUDY DESIGN: A retrospective cohort study. SETTING: A center for spine surgery, rehabilitation department and pain medicine. METHODS: Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations. RESULTS: The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body. LIMITATIONS: This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design. CONCLUSIONS: Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results. Trial registration: The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820). KEY WORDS: Percutaneous full-endoscope, anterior transcorporeal approach, cervical discectomy, cervical disc herniation, minimally invasive surgery

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Long-term clinical results of microsurgical transdural discectomy with laminoplasty: follow-up results over 10 years

Journal of Neurosurgery Spine ◽

10.3171/2013.3.spine12673 ◽

2013 ◽

Vol 18 (6) ◽

pp. 653-660 ◽

Cited By ~ 7

Author(s):

Nobuhiro Tanaka ◽

Yoshinori Fujimoto ◽

Tadayoshi Sumida ◽

Hideki Manabe ◽

Kazuyoshi Nakanishi ◽

...

Keyword(s):

Disc Herniation ◽

Japanese Orthopaedic Association ◽

Clinical Results ◽

Intervertebral Discs ◽

Cervical Disc ◽

Age At Surgery ◽

Long Term Follow Up ◽

Surgical Treatments

Object In this retrospective analysis the authors describe the long-term clinical results of microsurgical transdural discectomy with laminoplasty (MTDL) in patients with cervical disc herniation (CDH). Methods Thirty patients (21 males, 9 females; mean age at surgery 55 years) with CDH had surgical treatments consisting of MTDL between 1990 and 1998. All patients demonstrated signs or symptoms of cervical myelopathy and/or radiculomyelopathy. Clinical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scoring system and by recovery rate (RR). The degenerative grades of the intervertebral discs were also evaluated based on preoperative, postoperative, and final follow-up MR images. The average follow-up period was 14.1 years (range 10–22 years). Results Twenty (67%) of the 30 patients completed the follow-up in this study. The preoperative JOA scores in these patients averaged 11.8, and the postoperative scores at the final follow-up averaged 15.5 (average RR 69.6%). None of these patients required reoperation after MTDL. Although disc degeneration progressed during the follow-up period, there were no cases of clinical deterioration, recurrence of disc herniation, or postoperative kyphotic deformity. Conclusions Sufficient clinical results were obtained after the MTDL for a long-term follow-up period exceeding 10 years. The MTDL may be an option for an alternative procedure if the patients are correctly selected and the procedure is safely performed.

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