Reversal of Anterior Cervical Fusion with a Cervical Arthroplasty Prosthesis

Treatment of cervical non-union with cervical disc replacement: A case series

Introduction

Cervical disc replacement (CDR) has become prevalent in the treatment of cervical pathology. CDR is an appealing option for several reasons, including improvement of symptoms, preservation of range of motion, and the absence of risk for nonunion – a complication of an anterior cervical decompression and fusion (ACDF) surgery. In this case series, we explore the use of CDR to treat cervical nonunion.

Methods

Four patients, ages 50 to 64, presented to one surgeon with symptomatic cervical nonunion. Three of the four patients possessed risk factors for further nonunion and were therefore considered especially well-suited to a CDR rather than a revision ACDF. X-ray, MRI, and CT were used to confirm the presence of nonunion and to determine the architectural feasibility of replacing the level with a cervical disc arthroplasty. Six total nonunion levels were present in four patients (two levels in two patients and one level in two patients). Each of the nonunion levels was successfully treated with a revision decompression and CDR.

Results

Postoperatively, all four patients experienced improvement of nonunion symptoms. Neck Disability Index improved on average by 75% (preoperative score 51% to postoperative score 13%). Flexion-extension X-rays were available in three patients, which showed an increase in an average range of motion from 2 degrees to 7 degrees at the revised levels.

Conclusion

The series describing four successful cases expands the current literature and provides support for future investigation into CDR as a treatment for cervical nonunion. We propose CDR as a viable option to treat symptomatic cervical nonunion and restore range of motion in patients without significant arthrosis and with preserved endplate architecture.

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Cervical disc replacement as an emerging treatment option for preserving motion

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Four patients with confirmed nonunion successfully received disc replacement.

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All resolved symptoms, measured by NDI, and regained range of motion.

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CDR as viable treatment option for nonunion repair

Reversal of anterior cervical discectomy and fusion with cervical artificial disc replacement: regain motion after 9 years fusion

STUDY DESIGN

Case report and review of the literature.

OBJECTIVE

To present a conversion of an anterior cervical discectomy and fusion (ACDF) with a cervical artificial disc replacement in a 39-year-old woman and to review the relevant literature.

SUMMARY OF BACKGROUND DATA

Return of functional spinal unit motion 9 years after attempted fusion is extremely rare.

METHODS

The patient underwent an attempted anterior cervical discectomy and fusion 9 years earlier for bilateral hand numbness and leg weakness. Most of her neurological deficits had resolved after the index operation, but returned 2 months before the second operation and were unresponsive to nonoperative treatment. Computed tomography (CT) myelography showed recurrence of cervical disc herniation at the cephalad adjacent segment, which compressed the spinal cord. There was still some osteophyte at the C5/6 level that was also causing compression to the spinal cord. A solid fusion was suspected at this level. Surgery was performed to take down the grafted region and replace both levels with artificial disks.

RESULTS

The range of motion (ROM) of the revised level at the 6-month follow-up was well preserved, there was no sign of instability at either operated level. The 6-month follow-up CT scan shows that, there was no obvious compression in the spinal canal. The remobilized facet joints of C5/6 segment have not demonstrated further degeneration. The patient's neck symptom and neurological function were significantly recovered.

CONCLUSIONS

This case demonstrates application of a cervical artificial disc replacement to restore motion at a level that was previously grafted and fused. In select cases, cervical artificial disc replacement may represent a reasonable alternative to a repeated attempt at fusion. It is imperative that preoperatively lack of fusion of the facet joints be demonstrated on reconstructed CT scanning.

Cervical total disk replacement: complications and avoidance

Anterior cervical diskectomy and fusion for neurologic deficits, radicular arm pain, and neck pain refractory to conservative management are successful. The approach and procedure were first described in 1955 and have become the anterior cervical standard of care for orthopedic surgeons and neurosurgeons. Advancements and innovations have addressed disease processes of the cervical spine with motion-preserving technology. The possibility of obtaining anterior cervical decompression while maintaining adjacent segment motion led to the advent of cervical total disk replacement. The Food and Drug Administration has approved 3 cervical devices with other investigational device exemption trials under way.

Chiari malformation, cervical disc prolapse and syringomyelia--always think twice

We present the case of a 36-year-old man with neck pain and parasthesia of both upper limbs. Magnetic resonance imaging demonstrated a cervical disc protrusion with spinal cord compression, a Chiari I malformation and cervical syringomyelia. On clinical grounds it was suspected that the cervical stenosis was the symptomatic pathology and an anterior cervical decompression was performed, followed by arthroplasty. Post-operative imaging demonstrated adequate canal decompression, preserved cervical mobility and near-complete resolution of the syrinx. Syringomyelia has a multitude of causes and synchronous pathology can occur. Cervical spondylosis is infrequently associated with syringomyelia. Chiari I malformations are increasingly incidentally detected and asymptomatic. This first report of arthroplasty for cervical spondylosis associated with syringomyelia adds to the growing body of experience with this new technology.

Clinical report of cervical arthroplasty in management of spondylotic myelopathy in Chinese

OBJECTIVES

To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM) post-operatively.

METHODS AND MATERIALS

From 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels) of cervical spondylotic myelopathy (CSM) after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale) and radiological (X-ray of flexion, extension; left and right bending position) follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels.

RESULTS

At least 12 months follow-up were done in 65/83 of these patients. All of 83 patients were improved according to Odsm's scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73 degrees (3.7 degrees -5.9 degrees ) early postoperation and 8.12 degrees (5.8 degrees -13.6 degrees ) more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates (<1.5 mm) in 14/77 levels and (1.5-3 mm) in 4/77. heter-ossification was found in the replaced levels only in 2 cases.

CONCLUSION

Byran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.

Cervical spine arthroplasty biomechanics

The advent of cervical intervertebral disc replacement represents an exciting and new frontier in the treatment of myelopathy and discogenic pain. The goal of most disc arthroplasty designs is to attempt to approximate the normal spinal motion as much as possible. This survey article provides a general overview as to the goals of cervical disc replacement, the current state of knowledge concerning how these devices have been evaluated, and a commentary on future work that should be performed to characterize these devices fully.

Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients

OBJECT

The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression.

METHODS

During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease. A total of 24 devices were implanted. Six of the 15 patients had undergone a previous posterior foraminotomy, and in nine cases an anterior interbody fusion had been perfomed at some stage prior to surgery. Clinical and radiological evaluations were performed preoperatively and after surgery to assess outcomes. A total of 24 arthroplasties were performed encompassing between one and three levels. There were no major perioperative complications or immediate device-related failures. Two patients were lost to follow up. The follow-up period ranged from 12 to 43 months (mean 24.2 +/- 10.5 months). Good results were obtained in all cases as reflected by an increase in the visual analog scale score of 6.4 in terms of neck/arm pain (p < 0.05). There was no difference in Oswestry Disability Index scores for neck pain (p > 0.05) and no patient required surgery at the same level. In one patient hypermobility developed with internal subluxation of the device, which suggested a compromise adjacent to a two-level fusion at 21 months. The segment was hypermobile preoperatively. The patient has experienced recurrent neck pain but otherwise remains clinically well and has not required revision surgery to date.

CONCLUSIONS

Insertion of the Bryan artificial cervical disc in patients who have previously undergone cervical fusion or posterior foraminotomy, in general, appears to be safe. It provided encouraging early clinical results, although patients with preoperative hypermobility should be treated with caution. Issues such as accelerated device-related wear and the use of arthroplasty after aggressive facetectomy resection will need further study; however, in carefully selected patients who have undergone previous surgery cervical arthroplasty may provide an additional tool in the management of cervical disc disease.