Complications and Complication Avoidance With Cervical Total Disc Replacement

Abstract

Complications with cervical arthroplasty can be generalized to errors in patient selection or surgical technique. Patients with advanced spondylosis or osteophytic disease, severe facet arthropathy, osteoporosis, sagittal deformity, or preoperative instability are poor candidates for arthroplasty and are more prone to complications. Poor surgical technique can result in subsidence, expulsion, and kyphosis, and it can contribute to heterotopic ossification. Additionally, all of the inherent complications from an anterior cervical approach may occur with cervical artificial disc placement. This article will focus on the complications uniquely associated with cervical arthroplasty.

Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients

“…Some ACDR-specific complications may require revision or secondary surgery. 41 , 42 ) In ACDR surgery, the surgeon needs to achieve sufficient spinal cord and nerve roots decompression because the ROM of the surgical level is maintained, unlike in ACDF. Particular attention should be paid to ensuring that the neural foramen is sufficiently open in cases of stenosis due to mild formation of osteophyte ( Fig.…”

“…Implant-related complications such as hypermobility, HO, implant subsidence or migration, vertebral osteolysis or anterior bone loss, vertebral fracture, or local kyphosis are serious complications that must be avoided. 41 , 42 , 61 - 66 ) HO is one of the most common complications following ACDR. Although its risk factors are unclear, HO after ACDR causes a reduction in ROM at the indexed level after ACDR.…”

“… 34 - 40 ) Specific ACDR-related complications should also be carefully noted to ensure surgical safety. 41 , 42 ) A firm consensus on ACDR is yet to be established. There is another concern that different mechanical design of CAD may result in the different intervertebral mobility and stability.…”

An Atypical Presentation of Early Periprosthetic Infection After Cervical Disc Arthroplasty

“…Short-term complications of CDA are commonly related to the anterior cervical approach, similar to those seen in ACDF 1,11 . In the mid-term to long-term period, CDA may have unique complications such as heterotopic ossification and osteolysis, but most often patients are asymptomatic and do not require treatment 3,[12][13][14] . However, unlike other joint replacement procedures, the risk of delayed implant-related infection after CDA is extremely low [15][16][17] .…”

Is C7-T1 cervical disc replacement a viable technique: A case series

“…There is no established rate of subsidence at C7-T1, but subsidence is not unique to the cervicothoracic junction. The rate of clinically significant subsidence is disputed; however large studies report it as less than 3 % [15] . Despite this unfortunate complication, the patient's NDI score 18 months out from surgery was 38 %, significantly improved from the preoperative score of 72 %.…”