Abstract
Introduction
Cervical disk replacement seems to be a promising alternative to anterior cervical fusion. However, there is still lack of information about the generation of wear particles and local reaction to these particles in human cervical spine under in vivo conditions. The authors report clinical outcome and histological findings of three revised cervical prosthesis after a minimum of 18 months in function.
Materials and Methods
We report three patients who underwent revision of their cervical disk prosthesis after a minimum of 18 months in vivo. All patients were asymptomatic for a minimum of 6 months after initial procedure. Cervicobrachialgia was the most common presentation. Pain was measured using the self-reporting Visual Analogue pain Scale (VAS). The preoperative diagnostic algorithm consists of functional X-ray, cervical MRI, myelographie, postmyelo-CT, 3-phase bone scintigraphy, and SPECT-CT. All implants were retrieved and the surrounded soft tissue was histological evaluated. All patients were fused in the affected segment.
Results
The preoperative VAS-Score was 7, 3 + /−1. All implants were retrieved without any complications. All the prostheses were surrounded by a soft fibrotic tissue. Metal and PE debris with signs of foreign body inflammatory reaction was found within the surrounding soft tissue shell of the segment. The soft tissue toward epidural space caused narrowing of epidural space. Only one patient had a loosening of one endplate, which was visible in the preoperative scintigraphy. Two patients were pain free and one patient had minor neck pain (VAS 3) without radicular pain after the revision surgery.
Conclusion
Despite the limits of our case series, the results show that generation of wear debris and inflammatory reaction to these particles exist after cervical disk replacement. Revision surgery is promising in such patients after a standardized diagnostic algorithm. One goal of the next generation of cervical disk replacement should be low generation of wear particles and less biological active wear particles.
No
None declared