Assessment of Magnetic Resonance Imaging Artifact Following Cervical Total Disc Arthroplasty.

Abstract

Cervical disc arthroplasty has become a technique for the treatment of cervical degenerative disc disease. Clinically, the need to accurately assess the neural elements at the operative and adjacent levels is critical postoperatively. The purpose of this study was to quantitatively and qualitatively measure the amount of MRI artifact produced by various cervical total disc replacements. T1 and T2-weighted turbo spin-echo MRI sequences were collected on the cervical spine (C2-T1) of a 68 year-old unembalmed male cadaver. A discectomy was performed at C5-6, followed by successive implantation of six different total disc replacements. The scans were quantitatively evaluated by three of the authors. The volume of artifact was measured using image analysis software. Qualitative analysis of the adjacent and index neural elements was performed. The artifact in the T2 weighted images was noted to be 58.6±7.3 cm3 for Prestige ST, 14.2±1.3 cm3 for ProDisc-C, 7.5±0.8 cm3 for Discover, 8.0±0.3 cm3 for Prestige LP, 6.6±0.7 cm3 for Bryan, and 7.3±0.6 cm3 for ProDisc-C titanium prototype. Acceptable intraobserver and excellent interobsever correlation was demonstrated using Pearson Correlation and Concordance Correlation Coefficient analysis. The adjacent and implanted level neural elements (spinal cord and neuroforamina) were easily visualized on the T2 weighted images after the implantation of titanium devices (ProDisc-C titanium prototype, Discover, Prestige LP and Bryan). After implantation of a cobalt chrome implant (ProDisc-C), the adjacent level neural elements were easily visualized but the implanted level could not be fully visualized due to distortion of the images. The quality of the distortion was least favorable after the implantation of the stainless steel implant (Prestige ST), where neither the adjacent nor the index level could be fully visualized. The volume of the artifact seen following cervical total disc arthroplasty is highly dependent upon the material property of the implant. Quantitative analysis described in this study demonstrated sufficiently low intraobserver and interobserver variability to be considered a reliable technique.