Solid radiographic fusion with a nonconstrained device 5 years after cervical arthroplasty

Case report

View More View Less
  • Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Cervical disc arthroplasty (CDA) has been gaining popularity as a surgical alternative to anterior cervical discectomy and fusion. Spontaneous fusion following a CDA is uncommon. A few anecdotal reports of heterotrophic ossification around the implant sites have been noted for the BRYAN, ProDisc-C, Mobi-C, PRESTIGE, and PCM devices. All CDA fusions reported to date have been in devices that are semiconstrained.

The authors reported the case of a 56-year-old man who presented with left C-7 radiculopathy and neck pain for 10 weeks after an assault injury. There was evidence of disc herniation at the C6–7 level. He was otherwise healthy with functional scores on the visual analog scale (VAS, 4.2); neck disability index (NDI, 16); and the 36-item short form health survey (SF-36; physical component summary [PSC] score 43 and mental component summary [MCS] score 47). The patient underwent total disc replacement in which the DISCOVER Artificial Cervical Disc (DePuy Spine, Inc.) was used. The patient was seen at regular follow-up visits up to 60 months. At his 60-month follow-up visit, he had complete radiographic fusion at the C6–7 level with bridging trabecular bone and no motion at the index site on dynamic imaging. He was pain free, with a VAS score of 0, NDI score of 0, and SF-36 PCS and MCS scores of 61 and 55, respectively.

Conclusions

This is the first case report that identifies the phenomenon of fusion around a nonconstrained cervical prosthesis. Despite this unwanted radiographic outcome, the patient's clinical outcome was excellent.

Abbreviations used in this paper:

ACDF = anterior cervical discectomy and fusion; CDA = cervical disc arthroplasty; HO = heterotopic ossification; IDE = Investigational Device Exemption; MCS = mental component summary score; NDI = neck disability index; PCS = physical component summary score; SF-36 = 36-item short form health survey; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Artificial intervertebral disc arthroplasty for treatment of degenerative disc disease of the cervical spine. Technol Eval Cent Assess Program Exec Summ 26:14, 2011

    • Search Google Scholar
    • Export Citation
  • 2

    Bartels RH, & Donk R: Fusion around cervical disc prosthesis: case report. Neurosurgery 57:E194, 2005

  • 3

    Brenke C, , Scharf J, , Schmieder K, & Barth M: High prevalence of heterotopic ossification after cervical disc arthroplasty: outcome and intraoperative findings following explantation of 22 cervical disc prostheses. Clinical article. J Neurosurg Spine 17:141146, 2012

    • Search Google Scholar
    • Export Citation
  • 4

    Cepoiu-Martin M, , Faris P, , Lorenzetti D, , Prefontaine E, , Noseworthy T, & Sutherland L: Artificial cervical disc arthroplasty: a systematic review. Spine (Phila Pa 1976) 36:E1623E1633, 2011

    • Search Google Scholar
    • Export Citation
  • 5

    Chen J, , Wang X, , Bai W, , Shen X, & Yuan W: Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis. Eur Spine J 21:674680, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Choi D, , Petrik V, , Fox S, , Parkinson J, , Timothy J, & Gullan R: Motion preservation and clinical outcome of porous coated motion cervical disk arthroplasty. Neurosurgery 71:3037, 2012

    • Search Google Scholar
    • Export Citation
  • 7

    Coric D, , Cassis J, , Carew JD, & Boltes MO: Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. Clinical article. J Neurosurg Spine 13:715721, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Goffin J, , Casey A, , Kehr P, , Liebig K, , Lind B, & Logroscino C, et al.: Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery 51:840847, 2002

    • Search Google Scholar
    • Export Citation
  • 9

    Heller JG, , Sasso RC, , Papadopoulos SM, , Anderson PA, , Fessler RG, & Hacker RJ, et al.: Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34:101107, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Jaramillo-de la Torre JJ, , Grauer JN, & Yue JJ: Update on cervical disc arthroplasty: where are we and where are we going?. Curr Rev Musculoskelet Med 1:124130, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Jin YJ, , Park SB, , Kim MJ, , Kim KJ, & Kim HJ: An analysis of heterotopic ossification in cervical disc arthroplasty: a novel morphologic classification of an ossified mass. Spine J 13:408420, 2013

    • Search Google Scholar
    • Export Citation
  • 12

    Lee JH, , Jung TG, , Kim HS, , Jang JS, & Lee SH: Analysis of the incidence and clinical effect of the heterotopic ossification in a single-level cervical artificial disc replacement. Spine J 10:676682, 2010

    • Search Google Scholar
    • Export Citation
  • 13

    Lee SE, , Chung CK, & Jahng TA: Early development and progression of heterotopic ossification in cervical total disc replacement. Clinical article. J Neurosurg Spine 16:3136, 2012

    • Search Google Scholar
    • Export Citation
  • 14

    Leung C, , Casey AT, , Goffin J, , Kehr P, , Liebig K, & Lind B, et al.: Clinical significance of heterotopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery 57:759763, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    McAfee PC, , Cunningham BW, , Devine J, , Williams E, & Yu-Yahiro J: Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech 16:384389, 2003

    • Search Google Scholar
    • Export Citation
  • 16

    Mehren C, , Suchomel P, , Grochulla F, , Barsa P, , Sourkova P, & Hradil J, et al.: Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976) 31:28022806, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Moreland DB, , Asch HL, , Clabeaux DE, , Castiglia GJ, , Czajka GA, & Lewis PJ, et al.: Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft. Spine J 4:184191, 2004

    • Search Google Scholar
    • Export Citation
  • 18

    Murrey D, , Janssen M, , Delamarter R, , Goldstein J, , Zigler J, & Tay B, et al.: Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:275286, 2009

    • Search Google Scholar
    • Export Citation
  • 19

    Parkinson JF, & Sekhon LH: Cervical arthroplasty complicated by delayed spontaneous fusion. Case report. J Neurosurg Spine 2:377380, 2005

    • Search Google Scholar
    • Export Citation
  • 20

    Pimenta L, , McAfee PC, , Cappuccino A, , Bellera FP, & Link HD: Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J 4:6 Suppl 315S321S, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Sasso RC, , Anderson PA, , Riew KD, & Heller JG: Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am 93:16841692, 2011

    • Search Google Scholar
    • Export Citation
  • 22

    Suchomel P, , Jurák L, , Benes V III, , Brabec R, , Bradác O, & Elgawhary S: Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J 19:307315, 2010

    • Search Google Scholar
    • Export Citation
  • 23

    Summary of Safety and Effectiveness Data (SSED). Globus Medical (http://www.globusmedical.com/pdf/secure-c/SSED.pdf) [Accessed August 26, 2014]

    • Search Google Scholar
    • Export Citation
  • 24

    Tu TH, , Wu JC, , Huang WC, , Guo WY, , Wu CL, & Shih YH, et al.: Heterotopic ossification after cervical total disc replacement: determination by CT and effects on clinical outcomes. Clinical article. J Neurosurg Spine 14:457465, 2011

    • Search Google Scholar
    • Export Citation
  • 25

    Upadhyaya CD, , Wu JC, , Trost G, , Haid RW, , Traynelis VC, & Tay B, et al.: Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials. Clinical article. J Neurosurg Spine 16:216228, 2012

    • Search Google Scholar
    • Export Citation
  • 26

    Vital JM, , Guérin P, , Gille O, , Pointillart V, , Aurouer N, & Obeid I: The Mobi-C cervical disc prosthesis: indications, technique and results. Interactive Surgery 3:181186, 2008

    • Search Google Scholar
    • Export Citation
  • 27

    Yi S, , Kim KN, , Yang MS, , Yang JW, , Kim H, & Ha Y, et al.: Difference in occurrence of heterotopic ossification according to prosthesis type in the cervical artificial disc replacement. Spine (Phila Pa 1976) 35:15561561, 2010

    • Search Google Scholar
    • Export Citation
  • 28

    Yue JJ, , Bertagnoli R, , McAfee PC, & An HS: Motion Preservation Surgery of the Spine: Advanced Techniques and Controversies Philadelphia, Saunders/Elsevier, 2008

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 258 95 2
Full Text Views 393 16 0
PDF Downloads 288 18 0
EPUB Downloads 0 0 0