Objective: We investigated causes and results of revision surgeries after artiŞcial disc replacement ofcervical spine (C-ADR).Methods: Twenty-one patients (mean age: 52.8) who underwent revision surgery after C-ADR and whohad a minimum 2-year of follow-up were included into this study. The mean time between the primaryand revision surgeries was 21 months. During their primary surgeries, 14 patients underwent single levelC-ADR, 2 two-level C-ADR, and 5 two-level hybrid surgery for 16 radiculopathy, 3 myelopathy, and 2adjacent segment diseases. Causes for revision surgeries were at least one of the followings: 17 poorpatient selections, 7 insufŞcient decompressions, 7 malpositions, 6 subsidences, 3 osteolysis, and 1postoperative infection.Results: Sixteen patients underwent anterior removal of C-ADR, one-level discectomy and fusion(N¼ 11), two-level discectomy (N ¼ 3) or one-level corpectomy (N ¼ 2) and fusion. Three patients of keeltype C-ADR with heterotopic ossiŞcation underwent posterior laminoforaminotomy and fusion. Twopatients underwent combined procedures due to infection or severe subsidence and osteolysis. At the 2year follow-up, neck (7.3 vs 1.6) and arm (7.0 vs 1.3) visual analog scales and Neck Disability Index score(46.7 vs 16.32) were improved (all, p< 0.05). According to Odom's criteria, 86% of the patients weresatisŞed and 91% achieved solid fusion. No major complications developed except for transient dysphagiain 6 patients (29%).Conclusions: In this small case series, revision surgeries provided successful outcomes in failed C-ADRwithout major complications. Careful patient selection and meticulous surgical techniques are importantto avoid disappointing clinical outcome or even failure of C-ADR.Level of evidence: Level IV, Therapeutic study.
___
1. Sasso RC, Best NM, Metcalf NH, Anderson PA. Motion analysis of Bryan cervical disc arthroplasty versus anterior discectomy and fusion: results from a prospective, randomized, multicenter, clinical trial. J Spinal Disord Tech. 2008;21(6):393e399.
2. Cheng L, Nie L, Zhang L, Hou Y. Fusion versus bryan cervical disc in two-level cervical disc disease: a prospective, randomised study. Int Orthop. 2009;33(5):1347e1351.
3. Yang YC, Nie L, Cheng L, Hou Y. Clinical and radiographic reports following cervical arthroplasty: a 24-month follow-up. Int Orthop. 2009;33(4): 1037e1042.
4. Riew KD, Buchowski JM, Sasso R, Zdeblick T, Metcalf NH, Anderson PA. Cervical disc arthroplasy compared with arthrodesis for the treatment of myelopathy. J Bone Jt Surg Am. 2008;90(11):2354e2364.
5. Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. J Spinal Disord Tech. 2003;16(4):307e313.
6. Burkus JK, Traynelis VC, Haid Jr RW, Mummaneni PV. Clinical and radiographic analysis of an artificial cervical disc: 7-year follow-up from the Prestige prospective randomized controlled clinical trial. J Neurosurg Spine. 2014;21(4): 516e528.
7. Sasso RC, Smucker JD, Hacker RJ, Heller JG. Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech. 2007;20(7):481e491.
8. Nandyala SV, Marquez-Lara A, Fineberg SJ, Singh K. Comparison of revision surgeries for one- to two-level cervical TDR and ACDF from 2002 to 2011. Spine J. 2014;14:2841e2846.
9. Skovrlj B, Lee DH, Caridi JM, Cho SK. Reoperations following cervical disc replacement. Asian Spine J. 2015;9(3):471e482.
10. Singh K, Phillips FM, Park DK, Pelton MA, An HS, Goldberg EJ. Factors affecting reoperations after anterior cervical discectomy and fusion within and outside of a Federal Drug Administration investigational device exemption cervical disc replacement trial. Spine J. 2012;12(5):372e378.