Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.3047
Peer-review started: May 23, 2019
First decision: August 1, 2019
Revised: August 20, 2019
Accepted: August 27, 2019
Article in press: August 27, 2019
Published online: October 6, 2019
Cervical disc arthroplasty (CDA) is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility. However, the CDA postoperative period is impacted by osteolysis, subsidence, metallosis, or heterotopic ossification (HO). We report a case of severe HO in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty.
A 34-year-old man received hybrid surgery for C4-C5 and C5-C6 arthroplasty with Bryan discs and C6-C7 arthrodesis with polyetheretherketone cage due to traumatic herniation of the intervertebral disc (HIVD). After four years, cervical spine radiographs revealed severe HO around the Bryan discs over the C4-C5 and C5-C6 levels. The magnetic resonance image revealed HIVD over the C3-C4 level with spinal cord compression. Seronegative spondyloarthritis was diagnosed after consultation with a rheumatologist. A second CDA for the adjacent segment disease HIVD with Baguera C disc over the C3-C4 level achieved an excellent outcome.
Minimizing intraoperative tissue trauma and achieving postoperative interbody stability avoid soft tissue traction to prevent HO formation after CDA.
Core tip: Severe traction spur type heterotopic ossification (HO) occurred after cervical disc arthroplasty (CDA) with Bryan discs and matured in the second year after operation. A second CDA for the adjacent segment disease herniation of the intervertebral disc with Baguera C disc over the C3-C4 level achieved excellent outcome. Based on the second operation experience, the avoidance of unnecessary soft tissue traction and trauma such as burring, milling, or keeling during the operation and the prophylactic use of non-steroidal anti-inflammatory drugs are mandatory to prevent HO formation.