Complication Profiles Leading to Revision Surgery After Cervical Disc Arthroplasty

Abstract

Background:

Cervical disc arthroplasty (CDA) has gained widespread recognition as a motion-preserving alternative to anterior cervical discectomy and fusion for treating degenerative cervical disc disease. Over the past decade, the rate of CDA procedures has increased by a remarkable 654%. However, CDA complications can lead to a repeat procedure or can be converted to fusion.

Purpose:

We sought to evaluate the time of onset (early, intermediate, or late) of complications following CDA as well as the progression leading to revision surgeries.

Methods:

A retrospective review of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database examined complications across 9 CDA devices from January 1, 2005, to September 30, 2023. Complications were categorized by postoperative time to occurrence: early (<6 months), intermediate (6-18 months), and late (>18 months). The revision procedures were categorized as either a repeat CDA or conversion to fusion.

Results:

A total of 688 CDA revision cases were reviewed, with 265 cases (38.5%) reporting revision onset time (median: 12 months, interquartile range: 3-36). Migration was the most frequent complication in both the early (n = 44, 53.0%) and intermediate (n = 25, 32.1%) periods. Subsidence peaked during the intermediate period (11.5%, n = 9), while neck pain and heterotopic ossification (HO) occurred most in the late postoperative phase, at 22.5% (n = 23) and 7.8% (n = 8), respectively. The specific revision type was recorded in 509 of the revision cases; of these, 8 devices were predominantly associated with fusion (>69%), while Mobi-C showed a lower proportion of fusion revisions (16.2%).

Conclusions:

This retrospective review of the MAUDE database showed the timing of complications leading to CDA revision. Migration predominated in the early and intermediate phases, while subsidence peaked in the intermediate phase. In the late phase, neck pain, osteolysis, and HO become more prominent. Conversion to fusion was common across most devices. These data provide insight for clinicians to monitor patients after CDA while considering the relative frequencies of reported complications.

Level of Evidence:

Level IV: retrospective analysis of a prospectively maintained government database.

Plain Language Summary

Reasons for Revision Surgery After Cervical Disc Replacement: This study explores when and why complications occur after cervical disc replacement surgery, and how these issues lead to follow-up procedures. Using data from the Food and Drug Administration’s Manufacturer and User Facility Device Experience database, we analyzed 688 cases of revision surgery across 9 different disc replacement devices. Complications were classified based on when they occurred: early (within 6 months), intermediate (6-18 months), and late (after 18 months). Implant migration was the most common complication in the early and intermediate phases. Subsidence—when the implant sinks into the bone—was also frequent in the intermediate period. In the late phase, neck pain and abnormal bone growth around the implant (heterotopic ossification) were more common. Most patients who required revision surgery had their artificial disc removed and replaced with a spinal fusion. However, the Mobi-C implant stood out with a lower rate of fusion, likely due to its design, which allows for easier replacement. These findings offer insight into the timing and types of complications that can occur after cervical disc replacement, helping surgeons monitor patients and plan treatments more effectively.