Article
Complications of anterior discectomy with routinely performed bilateral uncectomy and implantation of artificial discs ProDisc-C type
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Authors
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Philipp Kuche
- Abteilung für Neurochirurgie und Wirbelsäulenchirurgie, ATOS Klinik Heidelberg
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Peter-Michael Zink
- Abteilung für Neurochirurgie und Wirbelsäulenchirurgie, ATOS Klinik Heidelberg
| Published: | June 2, 2015 |
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Outline
Text
Objective: Since 2000 artificial disc prostheses are available as implants after cervical discectomy.
The aim of this work is to depict complications and their frequency after ventral discectomy with bilateral radical uncectomie and implantation of artificial discs of type ProDisc-C.
Method: This is a single-center retrospective study of patient data, which were analyzed for complications.
Results: In the period from June 2004 to October 2014 in the Department of Spine- and Neurosurgery at ATOS Clinic Heidelberg 469 patients underwent cervical spine surgery via right side anterior approach and overall 769 artificial discs ProDisc-C type have been implanted. Follow-up check-ups were 6 weeks and 6 months after the surgical procedure. No intraoperative complication was seen. The following surgery-related complications resulted:
- 33 (7%) patients with right side recurrent nerve palsy. There was a significant higher risk when the segment C 6/7 was operated, and an increase in size of the thyroid gland was seen.
- 15 patients (3%) with dislocation of the implant which had to be revised.
- 4 patients (0.8%) with postoperative hemorrhage which required revision.
- 1 patient (0.2%) with CSF fistula, caused by posterior dislocation of the prosthesis.
- 1 patient (0.2%) with split fracture and consecutive necrosis of a vertebral body af-ter two level surgery.
- 2 patients with early postoperative infection.</li>
- 4 patients (0.8%) with reversible C 5 nerve palsy
- 14 patients (3%) with progressive degenerative changes one adjacent segment. All 14 received prosthetic disc replacement in the affected segment.
- 1 patient (0.2%) with perforation of a loose screw into the retropharyngeal space after revision with autologous bone graft, plate and screws.
Conclusions: The only complication which must be attributed to the prosthetic cervical spine implants is their dislocation. Their incidence is comparable with other, rigid implants. All other complications are associated with the operative pathway. Also their incidence is comparable to those shown by studies for operative fusions. One remarkable fact is the complete absence of intraoperative injuries of neck organs and the spinal cord. The postoperative nerve root dysfunction occurred to nerve root C 5 exclusively. In no case a physical damage of the nerve root was seen.
