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Intraoperative conversion of artificial cervical disc replacement to anterior cervical discectomy and fusion for iatrogenic fracture: A rare case report.

Abstract Artificial cervical disc replacement (ACDR) has been reported to be an effective and safe surgical treatment for cervical spondylosis. However, iatrogenic fracture during ACDR surgery has rarely been reported. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience and exploring when to convert ACDR to fusion intraoperatively.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29382028
OWN - NLM
STAT- MEDLINE
DCOM- 20180207
LR  - 20180207
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 47
DP  - 2017 Nov
TI  - Intraoperative conversion of artificial cervical disc replacement to anterior
      cervical discectomy and fusion for iatrogenic fracture: A rare case report.
PG  - e8917
LID - 10.1097/MD.0000000000008917 [doi]
AB  - RATIONALE: Artificial cervical disc replacement (ACDR) has been reported to be an
      effective and safe surgical treatment for cervical spondylosis. However,
      iatrogenic fracture during ACDR surgery has rarely been reported. Considering its
      infrequency, we report a rare clinical case, with the aim of sharing our
      experience and exploring when to convert ACDR to fusion intraoperatively.
      PATIENTS CONCERNS: A 47-year-old woman felt neck pain with weakness and numbness 
      in both upper limbs for 5 months. DIAGNOSES: The patient had received discectomy 
      and fusion procedure on C3/4 and C5/6 to relieve her radicular pain nearly 4
      years prior. Neurologic examination revealed a diminished sensation at the C6-C8 
      skin areas and level Grade-4 power in the left wrist extensor and grip muscle
      strength. Magnetic resonance imaging (MRI) showed disc herniation compressing the
      spinal cord at C6/7. Computed tomography (CT) scans showed intervertebral fusion 
      in both the C3/4 and C5/6 segments. INTERVENTIONS: Surgery was performed to
      remove the plate and replace C6/7 with an artificial disc, but a transverse
      cleavage endplate cortical fracture was detected after cutting the blades. Thus, 
      we terminated artificial cervical disc replacement intraoperatively and changed
      to discectomy and fusion in C6/7. OUTCOMES: The patient's symptoms were
      remarkably relieved. Postoperative CT scans showed a transverse cleavage fracture
      in the backside of the C6 caudal endplate. Good fusion was achieved after 6
      months. LESSONS: Iatrogenic fracture during ACDR is rare but does occur in clinic
      practice. Complete examination and an alternative approach determined before
      surgery are important for operative safety. Anterior cervical discectomy and
      fusion (ACDF) is recommended as a feasible remedial surgical strategy if ACDR
      fails intraoperatively.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Wang, Bei-Yu
AU  - Wang BY
AD  - Department of Orthopaedic Surgery, West China Hospital, Sichuan University,
      Chengdu, Sichuan, China.
FAU - Wu, Ting-Kui
AU  - Wu TK
FAU - Liu, Hao
AU  - Liu H
FAU - Deng, Yu-Xiao
AU  - Deng YX
FAU - Ding, Chen
AU  - Ding C
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Cervical Vertebrae/injuries/*surgery
MH  - Diskectomy/*methods
MH  - Female
MH  - Humans
MH  - Iatrogenic Disease
MH  - Intraoperative Period
MH  - Middle Aged
MH  - Reoperation/methods
MH  - Spinal Fractures/etiology/*surgery
MH  - Spinal Fusion/*methods
MH  - Spondylosis/surgery
MH  - Total Disc Replacement/*adverse effects
PMC - PMC5709027
EDAT- 2018/02/01 06:00
MHDA- 2018/02/08 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/08 06:00 [medline]
AID - 10.1097/MD.0000000000008917 [doi]
AID - 00005792-201711270-00119 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Nov;96(47):e8917. doi: 10.1097/MD.0000000000008917.