Delayed periprosthetic collection after cervical disc arthroplasty

Area of Science:

• Spine surgery
• Biomaterials
• Infectious disease

Background:

• Cervical disc arthroplasty (ACD) is a treatment for symptomatic cervical disc disease.
• Long-term safety and failure rates of ACD devices, including the M6-C artificial cervical disc, require further study.
• The M6-C disc features titanium alloy endplates and a polymeric centerpiece.

Observation:

• This case series reports on four patients who developed delayed prevertebral periprosthetic masses anterior to the M6-C disc.
• Patients presented with progressive dysphagia 2–7 years after M6-C disc implantation.
• Imaging revealed compressive masses anterior to the cervical disc replacement.

Findings:

• Intraoperative findings included soft-tissue masses and pus in two patients.
• Propionibacterium acnes infection was identified in three patients, treated with antibiotics.
• Histopathology showed inflammatory infiltrates and foreign body granulomas, suggesting infection or delayed hypersensitivity.

Implications:

• Delayed dysphagia post-M6-C disc implantation warrants investigation for mass lesions.
• This study is the first to report delayed infection or suspected hypersensitivity with the M6-C disc.
• Findings suggest adding these potential adverse events to M6-C disc safety concerns and call for prospective studies on incidence and long-term outcomes.