Infection Following Cervical Artificial Disc Replacement

Introduction: Cervical artificial disc replacement (ADR) is a procedure performed for patients with cervical disc degeneration or herniation in the setting of radiculopathy or myelopathy, with a primary 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 who develop cervical ADR infections.

Methods: We conducted a retrospective review of patients treated at our institution who developed infection following cervical ADR and underwent subsequent revision surgery. Data collected included patient demographics, clinical presentation, infective organism, and type of disc implanted. 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 in this study. 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. Head trauma preceded symptom onset in 3 patients. 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 in 16 cases and Staphylococcus epidermidis in 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. Variability in clinical presentation and time to diagnosis highlights the need to refine perioperative protocols to reduce infection risk and improve success of subsequent procedures. 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.