Surgical Technique, Subaxial Spine: Cervical Disc Replacement Revision Surgery

Abstract

Cervical disc replacement (CDR) has a high success rate. However, failure may occur due to persistent radiculopathy or myelopathy, malposition, heterotopic ossification, infection, subsidence, bearing wear, sizing error, and vertebral body fracture. Preoperative planning prior to revision surgery requires a complete history and physical, operative note from the index surgery, identification of implant information, imaging (radiographs, CT, and/or MRI), and determination of the etiology of CDR failure. Explanting the device and performing a fusion with a cage or graft may be performed for one-level revision. Corpectomy and fusion should be considered for two or greater levels of CDR revision because it reduces the number of graft-bone interfaces that require fusion, provides a large amount of autograft, affords stability, and removes the fibrinous on growth that occurs under the baseplates from the original surgery. Revision is associated with a greater complication rate than primary CDR, and consideration must be given to mitigating factors that predispose to adverse events.