Resident Physician University of Miami/Jackson Health System Miami, Florida, United States
Introduction: Cervical disc arthroplasty (CDA) is designed to preserve cervical motion in patients with degenerative spine pathologies. Several clinical trials have reported long-term outcomes and complications associated with CDA. Here we describe a single case in a patient with rheumatoid arthritis and clinical worsening one year after the index surgery who required removal of an epidural phlegmon associated with a CDA device. We also discuss the utility of preoperative evaluation with a single-photon emission computerized tomography (SPECT) scan to identify potential sites of inflammation when other imaging modalities are non-diagnostic.
Methods: A 28 year-old male patient with a history of rheumatoid arthritis and prior C6-7 CDA presented with worsening and debilitating axial neck and bilateral radicular arm pain. Preoperative workup with cervical single-photon emission computerized tomography (SPECT) scan demonstrated significant radiotracer uptake at the level of prior CDA. Therefore, removal of the disc arthroplasty followed by anterior cervical discectomy and fusion (ACDF) was performed. A review of the published literature regarding infections after CDA was also conducted.
Results: Intraoperatively, a large epidural phlegmon posterior to the CDA device, without frank purulence, was noted to be causing significant central and foraminal compression of neural structures and was evacuated. Similar to our findings, two other case reports were identified in the literature of delayed local infection following CDA with the same CDA device. Patients with underlying inflammatory arthropathies may be predisposed to inflammatory reactions and pseudotumor formation after spinal disc arthroplasty, potentially warranting a cautious approach when selecting this patient population for disc arthroplasty.
Conclusion : We present a case report of a young patient with rheumatoid arthritis and prior CDA who was found to have an epidural phlegmon related to the CDR at time of revision surgery. A review of the literature demonstrated a small number of case reports with delayed inflammatory reactions associated with a CDA device but a possible link between delayed inflammation and rheumatoid arthritis has not been previously identified.
How to Improve Patient Care: Delayed inflammatory reactions following CDA must be considered in patients with worsening or recurrent symptoms, particularly if they have an underlying inflammatory arthropathy.
