Infection Following Cervical Artificial Disc Replacement

Introduction: Cervical artificial disc replacement (ADR) is performed for patients with cervical disc degeneration or herniation with radiculopathy or myelopathy, offering the advantage of motion preservation compared to fusion procedures. Infection following cervical ADR is poorly understood, with no established guidelines for prevention or management. This case series aims to characterize the clinical presentation, microbiological findings, and outcomes of patients with cervical ADR infections.

Methods: We conducted a retrospective review of patients at our institution who developed infection following cervical ADR and underwent revision surgery. Data collected included patient demographics, clinical presentation, infective organism, and implant type. Infections were identified based on clinical symptoms and radiographical findings and confirmed with microbiological cultures. Infection management, including antibiotic therapy and revision surgery, was recorded.

Results: 31 cases involving 21 patients were included. 6 patients required two revision surgeries, and 2 patients required 3 revisions. Intractable neck pain and cervical radiculopathy were reported in nearly all patients. Upper extremity weakness, muscular spasms, balance issues, and dysphagia were also reported. Time from symptom onset to diagnosis ranged from 2 to 98 weeks (mean 33.8 weeks). Species most commonly isolated from OR cultures were Cutibacterium acnes (16 cases) and Staphylococcus epidermidis (7 cases). Cultures were negative in 4 cases. Intraoperative vancomycin powder was not used in any initial ADR surgery, and vancomycin powder or irrigation were utilized in 11 revisions. Notably, 19 patients (90.5%) eventually underwent cervical fusion, and 2 underwent revision ADR.

Conclusion : Infection following cervical ADR is rare but poses significant clinical challenges and most often requires conversion to fusion. Early identification and appropriate management are critical to optimizing patient outcomes. This study reports the largest cohort of patients with infected cervical ADRs to date and provides valuable insights to inform future guidelines for prevention and management.