Revision surgeries following artiŞcial disc replacement of cervical spine

Abstract

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.