Granulomatous reaction on a double-level cervical total disc arthroplasty : case report.

BACKGROUND: Cervical Total Disc Arthroplasty (TDA) or cervical artificial disc replacement (C-ADR) is an alternative technique to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative cervical spine disease. The main goal of TDA is to maintain cervical motion and therefore lower the risk of adjacent levels' deterioration. Granuloma formation on a cervical TDA is exceptional. We report such a case.

CLINICAL PRESENTATION: A 48-year-old female suffering from left cervico-brachialgia underwent a double-level TDA (SpinalKinetics® M6-C Artificial Cervical Disc) on C5-C6 and C6-C7 in another hospital in 2010. Two years later, she reported a recurrence of cervicalgia, refractory to conservative treatment by rigid collar and painkillers. Cervical MRI suggested a granulomatous formation on the C6-C7 prosthesis. She underwent the removal of her C6-C7 prosthesis which showed a rupture with nylon thread extrusion. We followed by an arthrodesis with plate. Follow-up showed improvement of her clinical status. Histopathologic studies showed a giant cell granulomatous formation in contact with nylon threads described in hip, shoulder and ankle arthroplasty. It has been described in 6 cases following lumbar TDA and 2 cases following cervical TDA.

CONCLUSION: We report a third case of granulomatous reaction on nylon thread extrusion after partial breakdown of a prosthesis for cervical TDA.