Avoiding cervical disc replacement complications: 7 things to know


Cervical disc replacement has grown in spine surgery, and there are some complications surgeons should be mindful of, Domagoj Coric, MD, wrote in a publication for the International Journal of Spine Surgery.

Seven things to know:

1. The FDA approved the first cervical disc replacement in 2007, and as the procedure became more popular, indications also grew for the procedure, according to the paper published Dec. 1. 

"The ideal indications of cervical arthroplasty include radiculopathy due to soft central/paracentral disc herniation, 1- and 2-level, in the setting of early, focal spondylosis," Dr. Coric wrote.

2. Well-characterized complications of cervical disc replacement include dislocation/expulsion, subsidence, osteolysis, recurrent radiculopathy, focal device kyphosis and heterotopic ossification. 

"One of the central themes of complication avoidance is understanding the mechanism of failure, whether the complication is related to surgical indication/patient selection, surgical technique, or the device itself," Dr. Coric wrote.

3. Spine surgeons should pay close attention to the presence of significant facet disease, the extent of bony foraminal stenosis, osteopenia/osteoporosis and degree of cervical spondylosis when assessing patients for cervical disc replacement. Often, cervical computed tomography is ideal for evaluating bony anatomy.

4. Attention to detail and symmetry during cervical disc replacement can reduce the chances of potential complications. 

"Adequate posterior release requires resection of the posterior longitudinal ligament and proximal, symmetrical foraminotomies with proximal uncovertebral joint resection, which facilitates disc space mobilization and allows for proper device sizing and optimal placement," Dr. Coric wrote. "Lack of proper release and mobilization predispose one to displacement and expulsion."

5. Heterotopic ossification doesn't require reoperation but it can limit motion. The risk of this can be lowered by reducing or eliminating high-speed drilling during surgery, Dr. Coric wrote. Focal device kyphosis is another complication that could limit motion, and using devices with robust, keel-based fixation should be a consideration.

6. Osteolysis can be destabilizing and may not be evident for several years. Metal-on-metal devices may predispose patients to osteolysis. This complication requires extended follow-up after cervical disc replacement with regular flexion and extension radiographs.


7. "Cervical arthroplasty complications are relatively rare and typically not catastrophic," Dr. Coric wrote. "Cervical arthroplasty revision, posterior or anterior, is generally straightforward, not necessarily requiring an exposure surgeon. The best way to prevent revision surgery and improve outcomes is complication avoidance."

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