A case of cervical metastases in a patient with preexisting cervical disc replacement and fusion after 2-year symptom-free interval: when do we need interdisciplinary diagnostics?

ABSTRACT

Recurrent cervical symptoms frequently occur after cervical disc replacement and fusion. To date, no algorithm for the diagnostic assessment of these symptoms has been established. We present a case report and review of the literature to illustrate the need for interdisciplinary diagnostics in recurrent cervicobrachialgia without pathological cervical imaging. The hospital chart, medical history, physical examination, and imaging of a single patient were reviewed. A 53-year-old man with preexisting cervical disc replacement and fusion presented with a new episode of cervicobrachialgia after a 2-year symptom-free interval. Cervical magnetic resonance imaging (MRI) showed no pathological findings. Six months later the patient reported increasing symptoms including numbness and weakness of the right arm. Repeated cervical MRI and thoracic computed tomography revealed cervical metastases with intraspinal tumor growth and an underlying extensive small cell bronchial carcinoma. In recurrent cervicobrachialgia, without pathological cervical imaging, interdisciplinary diagnostics are needed. Basic diagnostic tests may assist to exclude severe non-vertebrogenic pathologies.

• REFERENCES

• 1 Le H, Thongtrangan I, Kim DH. 2004; Historical review of cervical arthroplasty. Neurosurg Focus 17 (3) E1
• 2 McAfee PC. 2004; The indications for lumbar and cervical disc replacement. Spine J 4 (Suppl. 06) 177S-181S
• 3 Suchomel P, Jurak L, Benes 3rd V et al. 2010; Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J 19 (2) 307-315
• 4 Korinth MC. 2008; Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir 69 (3) 113-124
• 5 Pickett GE, Sekhon LH, Sears WR et al. 2006; Complications with cervical arthroplasty. J Neurosurg Spine 4 (2) 98-105
• 6 Denaro V, Papalia R, Denaro L et al. 2009; Cervical spinal disc replacement. J Bone Joint Surg Br 91 (6) 713-719
• 7 Bartels RH, Beems T, Schutte PJ et al. 2010; The rationale of postoperative radiographs after cervical anterior discectomy with stand-alone cage for radicular pain. J Neurosurg Spine 12 (3) 275-279
• 8 Bertagnoli R, Duggal N, Pickett GE et al. 2005; Cervical total disc replacement, part two: clinical results. Orthop Clin North Am 36 (3) 355-362
• 9 Mummaneni PV, Burkus JK, Haid RW et al. 2007; Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6 (3) 198-209
• 10 Murrey D, Janssen M, Delamarter R et al. 2009; Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9 (4) 275-286
• 11 Barbagallo GM, Assietti R, Corbino L et al. 2009; Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?. Eur Spine J 18 (Suppl. 01) 29-39
• 12 Shin DA, Yi S, Yoon do H et al. 2009; Artificial disc replacement combined with fusion versus two-level fusion in cervical two-level disc disease. Spine (Phila Pa 1976) 34 (11) 1153-1159 ; discussion 1160–1161
• 13 Shinomiya K, Okamoto A, Kamikozuru M et al. 1993; An analysis of failures in primary cervical anterior spinal cord decompression and fusion. J Spinal Disord 6 (4) 277-288
• 14 Yoon DH, Yi S, Shin HC et al. 2006; Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148 (9) 943-950
• 15 Lee IS, Kim HJ, Choi BK et al. 2007; A pragmatic protocol for reduction in the metal artifact and radiation dose in multislice computed tomography of the spine: cadaveric evaluation after cervical pedicle screw placement. J Comput Assist Tomogr 31 (4) 635-641
• 16 Sekhon LH, Duggal N, Lynch JJ et al. 2007; Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCM cervical arthroplasty devices. Spine (Phila Pa 1976) 32 (6) 673-680
• 17 Tominaga T, Shimizu H, Koshu K et al. 1995; Magnetic resonance imaging of titanium anterior cervical spine plating systems. Neurosurgery 36 (5) 951-955
• 18 Pillai P, Mendel E, Ray-Chaudhury A et al. 2010; Metastasis development at the site of cervical spine arthrodesis. Acta Neurochir (Wien) 152 (3) 509-513

• REFERENCES COMMENTARY

• 1 Pillai P, Mendel E, Ray-Chaudhury A et al. 2010; Metastasis development at the site of cervical spine arthrodesis. Acta Neurochir (Wien) 152 (3) 509-513
• 2 Sekhon LH, Duggal N, Lynch JJ et al. 2007; Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCm cervical arthroplasty devices. Spine (Phila Pa 1976) 32 (6) 673-680
• 3 Antosh IJ, DeVine JG, Carpenter CT et al. 2010; Magnetic resonance imaging evaluation of adjacent segments after cervical disc arthroplasty: magnet strength and its effect on image quality. J Neurosurg Spine 13 (6) 722-726