Potential Complications and Risks of Cervical Disc Replacement Surgery

Cervical artificial disc replacement surgery is a relatively safe procedure, but it is not without risks. Before a final decision is made about surgery, it is advisable to learn about the procedure’s risks and potential complications.

Potential Complications of Cervical Disc Replacement Surgery

Possible cervical disc replacement surgery complications include:

• General surgery risks. As with any surgery, there are risks of infection, excessive blood loss, and adverse reaction to medications.
• Difficulty with speaking and/or swallowing. After cervical disc replacement surgery, most people have soreness and swelling in the throat, which can cause trouble with speaking (dysphonia) and/or swallowing (dysphagia).
• Heterotopic ossification. Bone-like material may start to grow in soft tissues, such as muscles or ligaments, as a result of surgical trauma. Even in cases where heterotopic ossification occurs, it is unlikely to cause symptoms aside from reduced range of neck motion that might not even be noticed.¹Zhou HH, Qu Y, Dong RP, Kang MY, Zhao JW. Does heterotopic ossification affect the outcomes of cervical total disc replacement? A meta-analysis Spine (Phila Pa 1976) 2015;40(6):E332–E340. Heterotopic ossification is about twice as likely to occur in men.²Yi S, Shin DA, Kim KN, et al. The predisposing factors for the heterotopic ossification after cervical artificial disc replacement. The Spine Journal. 2013; 13(9): 1048-54. Some surgeons may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) which may limit the incidence of heterotopic ossification.
• Artificial disc migration. It is possible for the disc implant to move over time if its attachment to the bone weakens, or if the device’s hardware fails.
• Pain not relieved. Some patients do not experience symptom relief, even if the surgery is done correctly.
• Adverse reaction to metal. There have been a few reported cases of artificial discs with metal-on-metal bearings giving off metal ions that may react with nearby tissues to cause pain or eventual implant failure.

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• Paralysis. While extremely rare, it is possible for the spinal cord or a nerve root to be injured during the procedure, which could result in paralysis in one or more limbs.

Many other rare complications exist.

Risk Factors for Cervical Disc Replacement Surgery Complications

Some factors could increase a patient’s risk for complications during or after cervical disc replacement surgery, including:

• Multilevel surgery. The risk for complications, such as hardware failure or adjacent segment disease, is higher when 2 discs are replaced at the same time.
• Smoking. Multiple studies have found that smoking increases the risk for complications, such as infection, when recovering from surgery. Smoking also makes it harder for the bones to heal and increases the risk for adjacent segment disease.
• Severe spinal degeneration. If the cervical spine already has facet joint osteoarthritis or the disc has collapsed more than 50%, a cervical disc replacement is less likely to relieve pain and maintain motion at that spinal level. The longer symptoms have lasted, the higher the chance that permanent nerve damage has already occurred and cannot be relieved by surgery.

Severe spinal degeneration. If the cervical spine already has facet joint osteoarthritis or the disc has collapsed more than 50%, a cervical disc replacement is less likely to relieve pain and maintain motion at that spinal level. The longer symptoms have lasted, the higher the chance that permanent nerve damage has already occurred and cannot be relieved by surgery.

Other risk factors also exist. Before deciding on cervical ADR, it is advised to discuss with a doctor all treatment options and the risks for complications.