Baltus Cedric, Costa Emmanuel, Vaz Geraldo, Raftopoulos Christian
Department of Neurosurgery, Saint-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
Department of Neurosurgery, Saint-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
World Neurosurg. 2019 Feb;122:360-363. doi: 10.1016/j.wneu.2018.11.070. Epub 2018 Nov 17.
Cervical total disc arthroplasty (TDA), or cervical artificial disc replacement, is an alternative technique to anterior cervical discectomy and fusion for treatment of symptomatic degenerative cervical spine disease. The main goal of TDA is to maintain cervical motion and lower the risk of deterioration of adjacent levels. Granuloma formation on a cervical TDA is exceptional.
A 48-year-old woman with left cervicobrachialgia underwent a double-level TDA (M6-C Artificial Cervical Disc) on C5-C6 and C6-C7 at another hospital in 2010. Two years later, she reported a recurrence of cervicalgia, which was refractory to conservative treatment by rigid collar and analgesics. Cervical magnetic resonance imaging suggested a granulomatous formation on the C6-C7 prosthesis. She underwent removal of the C6-C7 prosthesis, which showed a rupture with nylon thread extrusion. An arthrodesis with plate was subsequently performed. Follow-up showed improvement of her clinical status. Histopathologic studies showed a giant cell granulomatous formation in contact with nylon threads described in hip, shoulder, and ankle arthroplasty. It has been described in 6 cases following lumbar TDA and 2 cases following cervical TDA.
We report a third case of granulomatous reaction on nylon thread extrusion after partial breakdown of a prosthesis for cervical TDA.
颈椎全椎间盘置换术（TDA），即颈椎人工椎间盘置换术，是治疗有症状的退行性颈椎疾病的一种替代技术，可替代颈椎前路椎间盘切除融合术。TDA的主要目标是保持颈椎活动度并降低相邻节段退变的风险。颈椎TDA术后形成肉芽肿的情况较为罕见。
一名48岁患有左颈臂痛的女性于2010年在另一家医院接受了C5-C6和C6-C7节段的双节段TDA（M6-C人工颈椎间盘）手术。两年后，她报告颈痛复发，采用硬颈托和镇痛药进行保守治疗无效。颈椎磁共振成像显示C6-C7假体上有肉芽肿形成。她接受了C6-C7假体取出术，术中发现假体破裂并伴有尼龙线挤出。随后进行了钢板融合术。随访显示其临床状况有所改善。组织病理学研究显示，在与尼龙线接触处有巨细胞肉芽肿形成，这种情况在髋关节、肩关节和踝关节置换术中也曾有描述。腰椎TDA术后有6例报告过，颈椎TDA术后有2例报告过。
我们报告了第三例颈椎TDA假体部分破裂后因尼龙线挤出导致肉芽肿反应的病例。
