title: Persistent axial neck pain after cervical disc arthroplasty: a radiographic analysis.
abstract: There is very little literature examining optimal radiographic parameters for placement of cervical disc arthroplasty (CDA), nor is there substantial evidence evaluating the relationship between persistent postoperative neck pain and radiographic outcomes.
  
  
  
  We set out to perform a single-center evaluation of the radiographic outcomes, including associated complications, of CDA.
  
  
  
  This is a retrospective review.
  
  
  
  Two hundred eighty-five consecutive patients undergoing CDA were included in the review.
  
  
  
  The outcome measures were radiological parameters (preoperative facet arthrosis, disc height, CDA placement in sagittal and coronal planes, heterotopic ossification [HO] formation, etc.) and patient outcomes (persistent pain, recurrent pain, new-onset pain, etc.).
  
  
  
  We performed a retrospective review of all patients from a single military tertiary medical center from August 2008 to August 2012 undergoing CDA. Preoperative, immediate postoperative, and final follow-up films were evaluated. The clinical outcomes and complications associated with the procedure were also examined.
  
  
  
  The average radiographic follow-up was 13.5 months and the rate of persistent axial neck pain was 17.2%. For patients with persistent neck pain, the rate of HO formation per level studied was 22.6%, whereas the rate was significantly lower for patients without neck pain (11.7%, p=.03). There was no significant association between the severity of HO and the presence of neck pain. Patients with a preoperative diagnosis of cervicalgia, compared to those without cervicalgia, were significantly more likely to experience continued neck pain postoperatively (28.6% vs. 13.1%, p=.01). There were no differences in preoperative facet arthrosis, pre- or postoperative disc height, segmental range of motion, or placement of the device relative to the posterior edge of the vertebral body.However, patients with implants more centered between the uncovertebral joints were more likely to experience posterior neck pain (p=.03).
  
  
  
  We found that posterior axial neck pain is relatively frequent after CDA, and patients with persistent neck pain were significantly more likely to have preoperative cervicalgia and develop HO postoperatively. We also found that patients with implants that were placed off-centered were less likely to also complain of neck pain, although the reasons for this finding remain unclear.
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Wagner
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Formby
authors.affiliation: Department of Orthopedic Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA. Electronic address: daniel.g.kang@gmail.com.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Kang
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Van Blarcum
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Cody
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Tracey
authors.affiliation: Department of Orthopedic Surgery, Columbia University Medical Center-The Spine Hospital, 5141 Broadway, 3 Field West, New York, NY 10034, USA.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Lehman
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Arthroplasty; Axial neck pain; Cervical disc arthroplasty; Cervical disc arthroplasty placement; Persistent pain following; Posterior neck pain; Radiographic evaluation of cervical disc