Long-Term Complication of Three-Level Cervical Artificial Total Disc Replacement: A Case Report

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Neurosurgery

Background:

• Anterior cervical discectomy and fusion (ACDF) is the traditional treatment for cervical degenerative disc disease (DDD).
• Cervical artificial total disc replacement (cTDR) offers motion preservation and may reduce adjacent segment disease, gaining popularity for DDD treatment.
• While approved for one to two levels in the US, cTDR is used for three or more levels internationally.

Observation:

• A 59-year-old male with a history of three-level cTDR (C4-C7) presented 10 years post-surgery with increasing neck pain and difficulty swallowing (dysphagia).
• Imaging revealed loosened hardware, bone loss around the implants, and a cyst causing mass effect on the hypopharynx.
• The patient had undergone the three-level cTDR procedure in Germany.

Findings:

• The patient's symptoms were attributed to complications from the multi-level cTDR, including hardware failure and cyst formation.
• Magnetic resonance imaging (MRI) and computed tomography (CT) scans confirmed hardware loosening and significant bone degradation.
• A cyst ventral to the C4-C5 level was identified, exerting pressure on the hypopharynx.

Implications:

• This case emphasizes the critical importance of long-term patient follow-up after cervical artificial total disc replacement, especially for multi-level procedures.
• Careful consideration of patient selection and surgical technique is vital when choosing between ACDF and cTDR for cervical degenerative disc disease.
• Successful management was achieved through posterior cervical fusion, indicating potential alternative surgical strategies for managing cTDR complications.