Abstract
BACKGROUNDCervical disc replacement (CDR) is an increasingly used alternative to fusion for symptomatic cervical disc disease. While more studies have suggested favorability of CDR over fusion procedures, limited data exist regarding implant fatigability. Here, the authors present a unique and previously unreported failure of the M6-C prosthesis causing spinal cord injury.OBSERVATIONSA 49-year-old female with history of cervical degenerative disease and prior C4–7 M6-C arthroplasty presented 9 years later after a minor fall from standing. She endorsed bilateral hand numbness ascending to forearms and shoulders, with dysesthesias and weakness. Imaging showed fractured arthroplasty penetrating the spinal cord. Revision surgery found a ruptured arthroplasty annulus with metal piece piercing the spinal cord. Partial C4 and C5 corpectomy was performed to remove the integrated fins of the arthroplasty and inspect the cord and dura. This was reconstructed with a corpectomy cage and plate. The patient made an excellent recovery, with improvement in her weakness and resolution of her sensory symptoms.LESSONSPossibility of fatigue-related failures presenting years after implantation have only been infrequently reported but can be catastrophic for patients. The authors encourage further discussions in this area, increased counseling with patients, and recommend a patient registry to better document adverse events.
Highlights
Cervical disc replacement (CDR) is an increasingly used alternative to fusion for symptomatic cervical disc disease
Examination was notable for mild weakness of her left deltoid and biceps (41/5) and loss of sensation over bilateral hands and forearms without myelopathy
A partial C4 and C5 corpectomy was performed to remove the integrated keels of the arthroplasty and inspect the cord and dura
Summary
Cervical disc replacement (CDR) is an increasingly used alternative to fusion for symptomatic cervical disc disease. The authors present a unique and previously unreported failure of the M6-C prosthesis causing spinal cord injury. OBSERVATIONS A 49-year-old female with history of cervical degenerative disease and prior C4–7 M6-C arthroplasty presented 9 years later after a minor fall from standing. She endorsed bilateral hand numbness ascending to forearms and shoulders, with dysesthesias and weakness. Studies have since documented long-term maintenance of motion[2] and cost-effectiveness of cervical disc replacement (CDR).[3,4]. Many comparisons between ACDF and CDR have shown superiority of arthroplasty in long-term functional outcomes, rates of ASD, and frequency of additional surgeries for single-level[5–12] and two-level replacements.[13–15]. We present a unique and previously unreported catastrophic complication from this device
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