Traumatic Migration of the Bryan Cervical Disc Arthroplasty

Abstract

Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively.

Keywords: cervical disk arthroplasty; cervical trauma; device failure; traumatic migration.

Fig. 1

Anteroposterior (A) and lateral (B) preoperative radiographs demonstrating spondylosis and anterior osteophyte formation at C5–C6.

Fig. 2

Sequential sagittal magnetic resonance image slices (A, B) demonstrating disk–osteophyte complex resulting in moderate central canal narrowing with moderate left and mild right neural foraminal stenosis at C5–C6.

Fig. 3

Anteroposterior (A) and lateral (B) immediate postoperative radiographs demonstrating well-positioned and appropriately sized single-level Bryan Cervical Disc arthroplasty device at C5-C6.

Fig. 4

Lateral (A), flexion (B), and extension (C) radiographs at 6 weeks postoperatively demonstrating no change in the location or placement of the device, without evidence of migration or subsidence.

Fig. 5

Anteroposterior (A) and lateral (B) radiographs at 3 months postoperation demonstrating no change in position of the implant.

Fig. 6

Anteroposterior (A), lateral (B), flexion (C), and extension (D) radiographs at 6 months postoperatively showing migration of the Bryan Cervical Disc device ∼2 mm anteriorly, without change in implant position on dynamic radiography.

Fig. 7

Anteroposterior (A) and lateral (B) immediate postoperative revision radiographs demonstrating an anterior cervical diskectomy and fusion at C5–C6.