Oral extrusion of implant after cervical disc arthroplasty: A case report

Short-term and Long-term Complications of Cervical Disk Arthroplasty

“…In a case report by Oh and colleagues, a 59-year-old male with C3-4 CDA presented at 8 weeks postoperatively with posterior neck pain, cough, and radiographic findings of osteolysis at the anterior bodies of C3 and C4. As the surgeon in the case report decided to watch and wait, by postoperative week 13, the superior plate of the implant had extruded and migrated into the hypopharyngeal/esophageal region, causing perforation 33 . Early detection of abnormal symptoms and radiographic changes in CDA patients can ameliorate the risk for complications.…”

“…31,32 In a meta-analysis by Zavras et al, 31 which included results from a single academic institution with 169 patients as well as 3976 total patients from systematic review reports an incidence of gross device extrusion of 1.2% and 0.3%, respectively. Failure of osseointegration leading to extrusion may also be related to inadequate preparation of the vertebral endplates before Difficulty swallowing 13,18,19 Some studies support the use of IV or local steroids intraoperatively to prevent soft tissue swelling [20][21][22] Laryngeal nerve injury 0-1.25 23 Hoarseness, dysphonia, risk for aspiration 16,23 Careful dissection and retraction of the longus colli muscle [24][25][26][27] Horner syndrome ~0.06 28 Ptosis, anhidrosis, and miosis 28 Careful dissection and retraction of the longus colli muscle 24-27 Hematoma ~0.1 29 May lead to airway compromise or compression of nearby neural structures 29,30 Meticulous hemostasis and caution around vascular structures 29,30 Gross extrusion 0.3 31 Failure of implant osseointegration, risk of device migration and potential esophageal perforation 31,32 Early detection of abnormal postoperative radiographs 33 IV indicates intravenously.…”

“…As the surgeon in the case report decided to watch and wait, by postoperative week 13, the superior plate of the implant had extruded and migrated into the hypopharyngeal/esophageal region, causing perforation. 33 Early detection of abnormal symptoms and radiographic changes in CDA patients can ameliorate the risk for complications.…”