J Korean Neurosurg Soc.  2018 Jul;61(4):530-536. 10.3340/jkns.2017.0186.

Rare Intractable Cervicalgia Related to Exaggerated Disc Height Distraction : Report of Two Cases and Literature Review

Affiliations
  • 1Department of Neurosurgery, Daegu Catholic University Medical Center, College of Medicine, Catholic University of Daegu, Daegu, Korea.
  • 2Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea. moo9924@khu.ac.kr

Abstract

We present two cases of unexpected postoperative intractable cervicalgia due to over-sized implant insertion during simple anterior cervical decompression and fusion (ACDF) or artificial disc replacement (ADR). These patients experienced severe cervicalgia mostly related to their neck motion even after standard cervical operations. In both cases, the restored disc heights after the operations were prominently greater than the preoperative disc heights. The patients had not responded to any of the conservative treatments, and unloading of these excessively distracted segments through ultimate revision surgery led to dramatic pain relief. This report emphasizes the increase in distractional forces that takes place after a standard ACDF or ADR, as well as the importance of a proper sized implant. It also includes the reviews of other biomechanical or clinical reports dealing with this issue, thereby cautioning the surgeons not to disregard these factors, which might have an adverse effect in patients with cervicalgia even after radiographically successful cervical procedures.

Keyword

Allografts; Total disc replacement; Cervicalgia; Decompression

MeSH Terms

Allografts
Decompression
Humans
Neck
Neck Pain*
Surgeons
Total Disc Replacement

Figure

  • Fig. 1. First operation in case 1 : anterior cervical decompression and fusion at C5–6. Pre-operative (A) and post-operative (B) T2-weighted magnetic resonance images with definite evidence of good decompression of preoperative herniated intervertebral disc at the left paracentral.

  • Fig. 2. Pre-operative lateral view of the plain radiograph shows the disc height at C5–6 level to be 4.67 mm (A), which overwhelmingly increased to 7.36 mm (B) after cage insertion and fusion.

  • Fig. 3. Post-operative lateral plain radiograph shows a well-inserted artificial disc and a decreased disc height of 5.81 mm.

  • Fig. 4. First operation in case 2 : artificial disc replacement at C6–7. Preoperative (A) and post-operative (B) T2-weighted magnetic resonance images with definite evidence of good decompression of preoperative herniated intervertebral disc at the right paracentral.

  • Fig. 5. Second operation in case 2 : anterior cervical decompression and fusion at C5–6. Post-operative lateral pain radiograph shows a well-inserted cage at C5–6.

  • Fig. 6. Pre-operative lateral view of the plain radiograph shows the disc height at C6–7 level to be 5.51 mm (A), which overwhelmingly increased to 7.72 mm (B) after artificial disc insertion.

  • Fig. 7. Post-operative lateral plain radiograph shows well inserted artificial disc and change of disc height from 7.72 mm to 6.29 mm.


Cited by  1 articles

The Effect of Hounsfield Unit Value with Conventional Computed Tomography and Intraoperative Distraction on Postoperative Intervertebral Height Reduction in Patients Following Stand-Alone Anterior Cervical Discectomy and Fusion
Jun Seok Lee, Dong Wuk Son, Su Hun Lee, Sung Soon Ki, Sang Weon Lee, Geun Sung Song, Joon Bum Woo, Young Ha Kim
J Korean Neurosurg Soc. 2022;65(1):96-106.    doi: 10.3340/jkns.2021.0131.


Reference

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