Delayed periprosthetic collection after cervical disc arthroplasty

Abstract

<jats:p>Cervical disc arthroplasty is a treatment option for symptomatic cervical disc disease. There is a paucity of literature on long-term safety outcomes, durability, and device-related failure rates. The M6-C artificial cervical disc is a device with titanium alloy endplates and a complex polymeric centerpiece. To date, trials have exhibited acceptable safety profiles.</jats:p><jats:p>This case series describes the presentation, management, and pathological findings of a delayed prevertebral periprosthetic mass anterior to the M6-C disc. Four patients at 3 different institutions underwent cervical disc replacement with the M6-C disc. Two to seven years postoperatively, they presented with dysphagia secondary to a compressive mass anterior to the disc. Case notes were reviewed to collect data on symptoms, management, and outcomes. The patients were systemically well and presented with progressive dysphagia. They had imaging findings of a mass anterior to the disc. They underwent a decompressive procedure, with 2 patients undergoing device removal and fusion. In 2 cases, a soft-tissue mass was seen intraoperatively, with frank pus. In 3 cases, <jats:italic>Propionibacterium acnes</jats:italic> was identified and antibiotic treatment given. Histopathology demonstrated mixed inflammatory infiltrates with foreign body–type granulomas. Postoperatively, the dysphagia resolved.</jats:p><jats:p>The development of delayed dysphagia in a patient with an M6-C disc should prompt investigation to identify a mass lesion. To the authors’ knowledge, this is the first report of delayed infection, or suspected delayed-type hypersensitivity reaction, following M6-C disc implantation. It is important for this to be added to the device safety concerns. Further prospective studies are needed to establish the incidence and the long-term safety and failure rates of the M6-C disc.</jats:p>

The lexicon for periprosthetic bone loss versus osteolysis after cervical disc arthroplasty: a systematic review

“…Duration of implantation prior to reoperation ranged from 15-96 months. Radiographic analysis was performed at multiple time points, with progressive osteolysis observed in eight articles [26][27][28][29][30][31][32]. In twelve articles, the implants were removed.…”

“…In eight articles, histological analysis was reported to confirm the radiographic and/or intra-operative diagnosis of osteolysis [29-33, 35, 36]. Two articles reported positive cultures for Propionibacterium acnes [29,30] and two for Staphylococcus epidermidis. [35,36] Some of the observations included abundant giant cells, granulomatous formation, macrophages, metal particles, and flakes of polymeric debris, which are features of a potentially osteolysis-inducing foreign body response [23].…”

“…Neck pain was most frequently reported for patients with osteolysis [26,27,30,[33][34][35][36][37][38]. Radicular symptoms were reported in four studies [28,33,35,38] and paresthesia was reported in three case reports [29,30,33].…”

“…Neck pain was most frequently reported for patients with osteolysis [26,27,30,[33][34][35][36][37][38]. Radicular symptoms were reported in four studies [28,33,35,38] and paresthesia was reported in three case reports [29,30,33]. Other symptoms accompanying osteolysis were: dysphagia, respiratory compromise, myelopathy, shoulder pain, distal upper extremity numbness, and decreased fine motor dexterity.…”

The Cervical Hybrid Arthroplasty

“…Semiconstrained implants allow motion just outside the physiologic norm in effort to theoretically decrease the mechanical stresses felt at both at the facet joints and the interface between the implant and the bony surfaces. While often successful, these varied designs have also brought with them a concomitant range of complications with documented occurrences of extrusions, heterotopic ossification, osteolysis, and hardware failure [16,23,[25][26][27][28].…”