Very Late Complications of Cervical Arthroplasty: Results of Two Controlled Randomized Prospective Studies

Robert J. Hacker, MD1

1Springfield, OR United States

Keywords: arthroplasty, outcome, cervical spine, randomized trial, complications

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     Several studies have shown cervical arthroplasty to be a safe and effective alternative to cervical fusion in the treatment of degenerative cervical disc disease. An appropriate follow up interval for arthroplasty hasn’t been defined. Delayed complications and revisions are known occurrences of large joint arthroplasty.
     This study examines delayed device-related complications in cervical arthroplasty patients.
     Between 2002 and 2006 94 patients were enrolled in FDA studies of the Bryan and Prestige LP cervical disc.
     Charts, imaging studies and hospital records were reviewed for those who returned beyond four years of follow up for neck related symptoms.
     Excluding adjacent segment disease that occurred with a similar rate for fusion and arthroplasty patients, five arthroplasty patients returned for evaluation of neck and arm pain between 48 and 72 months after surgery. Four patients had peri-device vertebral body bone loss. Three required revision surgery that included device explantation and fusion. In each case an adjacent segment was included in the revision strategy. The other patient noted symptom improvement and demonstrated bone healing on radiographs. All patients reported stabilization or improvement in symptoms. One patient had cervical myelopathy due to device related ventral effacement of the spinal cord and underwent explantation and revision.
     This is an evaluation of two completed prospective trials.
     Despite their similarities, cervical arthroplasty and fusion aren’t equivalent procedures in regards to very late complications and the need for long term follow up.
     Similar to large joint arthroplasty, surgeons and their cervical arthroplasty patients should be aware of the potential for late device-related complications and the need for revision surgery.


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