title: Very late complications of cervical arthroplasty: results of 2 controlled randomized prospective studies from a single investigator site.
abstract: METHODS
  Prospective, single-site, randomized, Food and Drug Administration-approved investigational device exemption clinical trials of 2 cervical arthroplasty (CA) devices.
  
  
  OBJECTIVE
  To evaluate complications with CA occurring more than 4 years after the surgical procedure in Food and Drug Administration clinical trials of the Bryan and Prestige LP arthroplasty devices.
  
  
  BACKGROUND
  Reports of several randomized clinical studies have shown CA to be a safe and effective alternative to anterior cervical fusion in the treatment of degenerative cervical disc disorders. A majority include follow-up intervals of 4 years or less.
  
  
  METHODS
  Between 2002 and 2006, 94 patients were enrolled in Food and Drug Administration studies of the Bryan and Prestige LP cervical disc devices. Charts, imaging studies, and hospital records were reviewed for those who underwent arthroplasty and returned more than 4 years after their surgical procedure with neck-related pain or dysfunction.
  
  
  RESULTS
  Excluding adjacent segment disease that occurred with a similar rate for patients who underwent fusion and arthroplasty, 5 patients, all treated with arthroplasty, returned for evaluation of neck and arm symptoms between 48 and 72 months after surgery. Four patients had peridevice vertebral body bone loss. One patient had posterior device migration and presented with myelopathy. Three required revision surgery and 2 were observed. Four patients maintained follow-up and reported stabilization or improvement in symptoms.
  
  
  CONCLUSIONS
  Despite their similarities, CA and fusion are not equivalent procedures in this study in regard to very late complications. Similar to large joint arthroplasty, delayed device-related complications may occur with CA. These complications commenced well beyond the time frame for complications associated with more traditional cervical spine procedures. Both patients and surgeons should be aware of the potential for very late device-related complications occurring with CA and the need for revision surgery.
  
  
  METHODS
  1.
authors: From the Oregon Neurosurgery Specialists, Springfield, OR.
authors: Francis M
authors: FM
authors: Hacker
authors: Rebecca M
authors: RM
authors: Babcock
authors: Robert J
authors: RJ
authors: Hacker
mesh_terms: D001178:Arthroplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013997:Time Factors