Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, United States; Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States.
Global Spine J. 2016 Feb;6(1):e15-20. doi: 10.1055/s-0035-1550092. Epub 2015 Apr 23.
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.
病例研究。目的：描述一例 Bryan 颈椎间盘（美国田纳西州孟菲斯美敦力 Sofamor Danek）置换术后 6 个月以上因低能量创伤导致的脱位和迁移病例。方法：回顾一位 Bryan 颈椎间盘置换术后创伤性迁移患者的住院、门诊和放射学病历。作者无相关披露信息。结果：一位 36 岁男性因慢性左侧上肢神经根病，在 C5-C6 行 Bryan 颈椎间盘置换术，症状完全缓解。在其指数手术后约 6 个月，他遭受了来自书架掉落的书的后颈椎低能量创伤。该损伤迫使他的颈部弯曲，尽管他没有神经根病症状复发，但影像学检查显示置换装置向前迁移。他接受了前路颈椎间盘切除和融合术的修正。结论：尽管极其罕见，但行颈椎间盘置换术的患者，即使在术后 3 至 6 个月后，外科医生也必须考虑到骨整合失败的可能性。对于像 Bryan 颈椎间盘置换术这样的压配或铣削式装置，这种担忧尤其重要，因为它们缺乏与相邻椎体的直接固定。我们正在考虑修改术后方案，以提高植入后的装置保护，甚至在术后 3 个月后。
