Infection following cervical artificial disc replacement

Infection following cervical artificial disc replacement (ADR) is poorly understood, with no established guidelines for prevention or management. This case series aimed to characterize the clinical presentation, microbiological findings, and outcomes of patients with cervical ADR infections.

The authors conducted a retrospective review of patients at their institution who developed infection following cervical ADR and underwent revision surgery. Data collected included patient demographics, clinical presentation, infective organism, and implant type. Infections were identified based on clinical symptoms and radiological findings and confirmed with microbiological cultures. Infection management, including antibiotic therapy and revision surgery, was recorded.

Forty-two cases involving 30 patients were included. Nine patients required 2 or more revision surgeries. Intractable neck pain and upper extremity pain were the most reported clinical symptoms at 83.3% and 38.1%, respectively. Time from symptom onset to diagnosis ranged from 4 days to 208 weeks (mean 44.2 weeks). The top 3 species most commonly isolated from disc space cultures were Cutibacterium acnes (n = 22, 52.4%), Staphylococcus epidermidis (n = 11, 26.2%), and Propionibacterium acnes (n = 7, 16.7%). Cultures were negative in 5 (11.9%) cases. Notably, 27 of 30 patients (90.0%) eventually underwent conversion to fusion. Furthermore, regarding clinical improvement in symptoms, a majority of patients (21/30 patients, 70.0%) experienced symptom improvement or resolution, while 8 (26.7%) had persistent symptom and 1 patient (3.3%) was lost to follow-up.

Infection following cervical ADR is rare but poses significant clinical challenges, with most patients requiring conversion to fusion. Early identification and appropriate management are critical to optimizing patient outcomes. This study reports the largest cohort of patients with infected cervical ADRs to date and provides valuable insights to inform future guidelines for prevention and management.