Early catastrophic posterior migration of a cervical disc replacement polyethylene insert resulting in complete spinal cord injury: illustrative case.

BACKGROUND

Posterior migration of a mobile-bearing cervical disc replacement (CDR) can be catastrophic. The authors report a single-patient case of catastrophic failure after recent trauma and implant loosening.

OBSERVATIONS: A 48-year-old woman had received C5-6 and C6-7 Mobi-C CDRs at an outside institution 3 weeks before presentation and had sustained a ground-level fall 8 days before presentation. Outside imaging from after the fall showed implant loosening. After subsequently lifting a laundry basket, the patient developed acute quadriparesis with complete motor and sensory loss below C7. CT demonstrated catastrophic C5-6 and C6-7 hardware failure with posterior migration of the C6-7 polyethylene insert into the canal. Emergency revision C5-7 anterior cervical discectomy and fusion was performed, but she remained American Spinal Injury Association Impairment Scale grade A at the 1-year follow-up.

LESSONS: Patients with recent trauma and radiographic evidence of loosening, posterior endplate translation, loss of endplate parallelism, or polyethylene core malposition should prompt urgent surgical evaluation and likely revision. https://thejns.org/doi/10.3171/CASE26740.