scholarly journals Cervical disc arthroplasty at C2–3: illustrative case

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.

Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial

Neurosurgery ◽  
2020 ◽  
Author(s):  
Kee Kim ◽  
Greg Hoffman ◽  
Hyun Bae ◽  
Andy Redmond ◽  
Michael Hisey ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Disc Arthroplasty ◽  
Arm Pain ◽  
Pain Outcomes ◽  
Neck Disability

Abstract BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.

174 Comparison of 7-Year Results of One-Level versus Two-Level Cervical Disc Arthroplasty and Fusion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 245-245
Author(s):  
Todd H Lanman
Keyword(s):  
Clinical Trials ◽  
Neck Pain ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Propensity Score Method ◽  
Disc Disease ◽  
Disc Arthroplasty ◽  
Arm Pain ◽  
Sf 36 ◽  
Level Versus

Abstract INTRODUCTION Two independent clinical trials concluded that cervical disc arthroplasty (CDA) is as safe and effective as anterior cervical discectomy and fusion (ACDF) for treating cervical disc disease (CDD) at one and two levels. This study compared the safety and effectiveness at 7-year follow-up for subjects treated with CDA versus ACDF at 1 and 2-levels. METHODS Retrospective analysis of combined data from 1 and 2-level FDA IDE clinical trials. Outcomes were compared between 1-level and 2-level CDA and ACDF subjects. Propensity score method was used for an adjusted means analysis. RESULTS >There were no preoperative differences between 1 and 2-level CDA and ACDF patients for NDI, neck/arm pain, and SF-36 PCS. Comparing 1 vs 2-level CDA: there were no differences between 1 and 2-level CDA for NDI improvement (38.2 vs 39.0, P = 0.768), neck pain (11.7 vs 12.3, P = 0.374), arm pain (11.3 vs 11.0, P = 0.736), SF-36 PCS (12.6 vs 14.5, P = 0.220), or rates of neurological success (92.8% vs 91.6%, P = 0.867). Secondary surgeries were numerically higher for 1-than 2-level CDA at index and adjacent levels (7.3% vs 4.2%, P = 0.566) and (11.6% vs 6.5%, P = 0.056) respectively. Rates of serious AEs were significantly higher for 1 than 2-level CDA (67.8% vs 56.7%, P = 0.004). Comparison of 1 vs 2-level ACDF: there were no differences between 1 and 2-level ACDF for NDI improvement (31.1 vs 31.6, P = 0.859), neck pain (9.7 vs 9.9, P = 0.796), arm pain (9.9 vs 10.1, P = 0.848), SF-36 PCS (10.8 vs 12.1, P = 0.424), rates of neurological success (79.7% vs 82.1%, P = 0.421), or rates of secondary surgeries at index levels (13.6% vs 14.7%, P = 0.631) or adjacent levels (10.9% vs 12.5%, P = 0.366). Rates of serious AEs were similar for 1 and 2-level ACDF (61.8% vs 68.2%, P = 0.200) but rates of all AEs (94.5% vs 98.2%, P < 0.001) and device-related AEs (18.9% vs. 27.7%, P = 0.036) were significantly lower for 1 versus 2-level ACDF. CONCLUSION One and 2-level CDA appear to be equally safe and effective in the treatment of CDD at 7-years. Two-level ACDF was equally effective as 1-level, but 2-level ACDF had a higher rate of device-related AEs.

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

2021 ◽  
Vol 2 (8) ◽  
Author(s):  
Che-Han Hsu ◽  
Yi-Hsuan Kuo ◽  
Chao-Hung Kuo ◽  
Chin-Chu Ko ◽  
Jau-Ching Wu ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Disc Herniation ◽  
Late Complication ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Illustrative Case ◽  
Clinical Effects ◽  
Secondary Surgery ◽  
Disc Arthroplasty

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.

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.

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

2016 ◽  
Vol 24 (5) ◽  
pp. 752-759 ◽  
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.

scholarly journals Two-level cervical disc arthroplasty in patients with Klippel-Feil syndrome: A case report and review of the literature

2020 ◽  
Vol 11 ◽  
pp. 322
Author(s):  
Robert C. Ryu ◽  
Phillip H. Behrens ◽  
Blake A. Burkert ◽  
J. Patrick Johnson ◽  
Terrence T. Kim
Keyword(s):  
Cervical Vertebrae ◽  
Chronic Neck Pain ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Review Of The Literature ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Disc Arthroplasty ◽  
Neurologic Sequelae

Background: Klippel-Feil syndrome (KFS) is defined by multiple abnormal segments of the cervical spine with congenital synostosis of two or more cervical vertebrae. KFS patients who demonstrate progressive symptomatic instability and/or neurologic sequelae are traditionally managed with operative decompression and arthrodesis. Case Description: A 44-year-old female with chronic neck pain and radiculopathy and a C7-T1 KFS presented with adjacent segment degenerative disc disease at the C5-6 and C6-7 levels. She was successfully managed with a two-level cervical disc arthroplasty (CDA). Conclusion: Patients with KFS and disease at two contiguous, adjacent levels (e.g., cervical disc disease) may be safely and effectively managed with two-level CDA.

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