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Complications Cervical Total Disc
Replacement
Bobby KB Tay MD
Clinical Professor
Department of Orthopaedic Surgery
University of California at San Francisco
Director UCSF Spine Fellowship
Medical Director UCSF Spine Center
UCSF Complex Techniques in Spine Surgery
November 6, 2015
Disclosures
Depuy/Synthes Spine honoraria
Stryker Spine consultant, honoraria, royalties
Fellowship support: AOSpine, Nuvasive, Globus
Cervical disc arthroplasty is approved in the U.S. for only
single level and 2 level use from C3-C7
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Cervical TDR RCT NDI
* 0
20
40
60
80
100
Prestige
ACDF
0
20
40
60
80
100
Bryan
ACDF* * * *
0
20
40
60
80
100
preo
p
6wk
3mo
6mo
12m
o
18m
o
24m
o
Mobi-C
ACDF
0
20
40
60
80
100
preo
p
6wk
3mo
6mo
12m
o
18m
o
24m
o
36m
o
48m
o
84m
o
prodisc C
ACDF
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Secondary Procedures @ Index Level Prodisc C
(Delamarter et. al SASJ 2010)
ProDisc-C – 3 converted to fusion for pain
– Revisions performed by non-IDE study surgeons
Prestige revisions 1.4% at 5 years (Mummaneni and Burkus JNS Spine
2010)
24 months 48 months
ACDF 8.5%
(9 patients total)
11.3%
(12 patients total)
ProDisc®-C 1.9%
(2 patients total)
2.9%
(3 patients total)
Complications of cTDR
Poor preoperative planning
– Patient Selection
Intraoperative
– Problems with technique
– Visualization
Post-operative problems
– Early
– Intermediate
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Patient Selection
Contraindications to cTDR
Cervical instability (translation >3 mm and/or
>11° rotational difference to that or either
adjacent level)
Known allergy to implant materials (titanium,
polyethylene, cobalt, chromium, and
molybdenum)
Posttraumatic vertebral body
deficiency/deformity
Facet joint degeneration
Neck or arm pain of unknown etiology
Axial neck pain as the solitary presenting
symptom
Severe spondylosis (bridging osteophytes, disc
height loss >50%, and absence of motion
<2°)
Osteoporosis/osteopenia
Prior surgery at the level to be treated
Active malignancy; any patient with history of
invasive malignancy, unless treated and
asymptomatic for at least 5 years
Presently on medications that can interfere with
bone/soft tissue healing (ie, steroids)
Autoimmune spondyloarthropathies
(rheumatoid arthritis
Active local/systemic infection
Autoimmune spondyloarthropathies
(rheumatoid)
Pregnant
Other metabolic bone disease (ie, Paget's and
osteomalacia)
Morbid obesity (BMI>40 or weight>100 lb over
ideal body weight)
Adapted from Auerbach, Balderston , Spine Journal 2008
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Nickel Chromium
Cobalt
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41-year-old reports two years of worsening neck and right shoulder complaints. The
patient also complains of right intermittent pain and numbness in the C7 distribution.
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Choose the Right Patient
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Intraoperative Complications
Suboptimal placement
Suboptimal decompression
Overly aggressive bone
removal
Intraoperative vertebral body
fracture
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Be aware of Creating Coronal Plane Deformity
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Post-operative Complications
Subsidence
Heterotopic ossification
Implant
migration/loosening
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Subsidence
Heterotopic Ossification
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Difference in Occurrence of Heterotopic Ossification
According to Prosthesis Type in the Cervical Artificial
Disc Replacement SPINE 2010
Seong Yi, MD, PhD,* Keung Nyun Kim, MD, PhD,* Moon Sul Yang, MD,*
Joong Won Yang, MD,* Hoon Kim, MD,* Yoon Ha, MD, PhD,* Do Heum Yoon, MD, PhD,*
and Hyun Chul Shin, MD, PhD†
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Loss of motion
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Conclusion
Good evidence showing
cervical disc arthroplasty is
a safe procedure
compared to ACDF
Complications are often
due to poor patient
selection or stretching
indications
We will face further
challenges as the bearing
surfaces wear out.
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