Postoperative MRI Visualization of the Cervical Spine Following Cervical Disc Arthroplasty: A Prospective Single-Center Comparison of a Titanium and Cobalt-Chromium Prosthesis

Abstract

Study Design: Prospective non-randomized single-center cohort study. Objectives: To analyze the quality of postoperative magnetic resonance imaging of 2 structurally different cervical disc arthroplasty devices at the index and adjacent levels. Methods: A non-randomized, comparative, prospective, single-center study included 40 patients (23 men and 17 women) aged 32 (26-40) years. Two study groups were utilized: in the first (n = 20), a titanium prosthesis was used; in the second (n = 20), a cobalt-chromium implant was used. Evaluation of MRI studies before and after surgery was performed using sagittal and axial T2 weighted images by 2 specialists who were blinded to the prosthesis that was used. To determine the quality of an MRI image, the classification of Jarvik 2000, the radiological and orthopedic scales for assessing artifacts were used. Results: There was good-to-excellent inter-observer agreement for all of the MR parameters used for the titanium and satisfactory-to-good for the cobalt chromium group. The analysis of the quality of postoperative imaging using the Jarvik 2000 scale showed a statistically significant deterioration in MR images in the cobalt chromium group ( P < 0.001), compared to the titanium ( P = 0.091). Following a single-level total arthroplasty, the titanium group had better MRI images according to radiological and orthopedic scales ( P < 0.001). Conclusion: Titanium cervical disc arthroplasty devices result in superior postoperative MR imaging, as compared to cobalt chromium prostheses, as the latter significantly reduces image quality due to the pronounced ferromagnetic effect.

An Atypical Presentation of Early Periprosthetic Infection After Cervical Disc Arthroplasty

“…In evaluating for osteomyelitis, fluid-sensitive MRI sequences are the most sensitive, but metal artifacts from implant materials can hinder accurate assessment of the surrounding bones and neurological structures, as illustrated in Figure 6. Hence, the imaging characteristics of implants are an important factor to consider in decision-making, the most favorable being titanium-coated polyetheretherketone-on-ceramic implants currently, which produce virtually no artifact on MRI 29,30 . In cases where MRI results are inconclusive, SPECT/CTscans have proven to be a reliable diagnostic tool for identifying pseudoarthrosis, implant loosening, adjacent segment degeneration, osteomyelitis, and device-related infections [31][32][33][34] .…”

Comparison of MRI Visualization Following Minimally Invasive and Open TLIF: A Retrospective Single-Center Study

“…Rigid stabilization of the spine leads to significant biomechanical changes and overload of adjacent segments, accelerating their degeneration [1,5]. In addition, classical decompression and stabilization interventions are associated with substantial damage and atrophy of the multifidus muscle, which maintains the dynamic lumbar and spinal pelvic balance [14].…”

“…18Cr-14Ni-2.5Mo 36.1 [11] Co-18Cr-6Mo 8.37 [18] Ti-6Al-4V 4.52 [18] Ti-Gr2 2.43 [11] Zr-1Mo 1.05 [11] Op-TLIFs are often limited to the use of transpedicular screw fixation systems to stabilize the posterior support complex. In contrast, MI techniques can use a more comprehensive selection of implants, including interspinous spacers and transfacet stabilization [5]. Despite the different clinical and instrumental indications for using the implants mentioned above, the main goal of such techniques is complete decompression and effective stabilization, reducing the trauma of surgical intervention [2,3].…”

“…At the same time, minimally invasive (MI) decompression and stabilization techniques are actively used in modern spinal surgery and associated with better clinical outcomes due to less paravertebral tissue damage, minimum postoperative pain syndrome, and shorter recovery [3,4]. Adverse consequences of such interventions can be cage migration, instability of the structure, degeneration of the adjacent level, and postoperative muscle atrophy; for these reasons, complete visualization of the operated and adjacent levels is a mandatory requirement for medical implants [5,6]. Even in cases where a patient has complete functional recovery, imaging is necessary following instrumental fixation to assess the degree of nerve decompression, study the state of adjacent segments and paravertebral muscles, and assess the interbody fusion formation [7].…”

Patient Safety in MRI with the Use of a Joint-Spanning External Fixator for Knee Dislocation

“…Ferromagnetic devices may interact with the MR field and have the potential to cause patient harm through heating, movement, or projectile events 28 . More modern external fixators have eliminated delta ferrite, predominantly using titanium or other metals without delta ferrite, which yield little to no ferromagnetism 7,10,15,[29][30][31] . The metals used in various brands of knee-spanning external fixators tend to vary.…”