Intraoperative Anterior Migration of the Prestige-LP Cervical Disc Owing to an Inappropriate Implantation Sequence During Continuous 2-Level Artificial Cervical Disc Replacement: A Case Report with 8-Year Follow-Up.

Abstract

Owing to its unique advantages, 2-level artificial cervical disc replacement (ACDR) is gaining attention. Among artificial discs designed for use in ACDR, the Food and Drug Administration-approved Prestige-LP Cervical Disc is widely used. There are no standard implantation sequences for 2-level ACDR using the Prestige-LP disc, and complications resulting from inappropriate implantation sequences remain unknown. A 45-year-old woman underwent continuous 2-level ACDR using the Prestige-LP disc and experienced anterior migration of a previously inserted artificial disc after secondary disc implantation at an upper segment owing to an inappropriate implantation sequence during surgery. Intraoperative radiographs showed stable index levels and artificial discs. We tapped the migrated disc back into its correct position and recommended a postoperative functional exercise plan to the patient. We followed the patient for 8 years to verify the safety of our solution. We developed an implantation strategy for 2-level ACDR to avoid this complication in the future. During 2-level ACDR, a top-down sequence should be used to implant prostheses. When anterior disc migration occurs, intraoperative radiographs should be obtained to ensure stability of the index levels. If there is no instability, the migrated tab can be tapped back into its correct position. In addition, limiting motion rather than allowing intermittent movement of the neck for at least 3 months is important to promote union between bone and prosthesis.