Persistent Axial Neck Pain after Cervical Disc Arthroplasty

Abstract

Introduction There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty (CDA). In addition, there is very little literature examining optimal radiographic parameters for placement of CDA. Therefore, we set out to perform a single-center evaluation of the radiographic outcomes and association with complications following CDA. Methods We performed a retrospective review from August 2008 to August 2012 of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty. Preoperative, immediate postoperative, and final follow-up films were evaluated. The clinical outcomes and complications associated with the procedure were also examined. Results A total of 312 patients were included in the review, with an average radiographic follow-up of 14 months and a 15.1% rate of persistent axial neck pain. For patients with persistent neck pain, the rates of heterotopic ossification (HO) formation and osteolysis were 27.7% and 14.9%, respectively, while the rates were significantly lower for patients without neck pain (12.8% and 6.2%, respectively, p = 0.01). There were no differences in preoperative facet arthrosis, pre- or postoperative disc height, segmental range of motion, or placement of the device relative to the posterior edge of the vertebral body. However, patients with implants more centered between the uncovertebral joints were more likely to experience posterior neck pain ( p =0.03). Conclusions We found that posterior, axial neck pain is relatively frequent after cervical disc arthroplasty, and patients with persistent neck pain were significantly more likely to develop heterotopic ossification or implant-related osteolysis. We also found that patients with implants that were placed off-centered were less likely to also complain of neck pain, though the reasons for this finding are unclear.