Over the past two decades, more than 18 million spinal surgeries have been performed in the United States, and cervical disc replacements represent a fair share of those.3 Long-term outcomes depend heavily on the structural integrity and design of the implanted device.
Device recalls due to design flaws can place patients in difficult clinical situations, especially those who are symptomatic and reluctant to undergo revision surgery. The research demonstrates that recalls on disc implants are not infrequent; about one in 20 implants.1
History
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CLINICAL PEARLS
For chiropractors treating patients with prior cervical instrumentation, this case underscores the importance of:
- Thorough history and imaging review
- Informed consent about surgical hardware
- Appropriate selection of non-cervical manipulative techniques
- Integration of therapeutic rehabilitation
- Co-management with medical professionals
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A 52-year-old female presented to our clinic with a six-month history of worsening neck pain, which she described as sharp, centered in the lower cervical spine, radiating into the left scapular region. The pain flared sharply with sustained cervical flexion or rotation. She also reported generalized neck fatigue, upper trapezius tightness and mid-thoracic discomfort. Notably, she denied any current paresthesia, numbness or loss of grip strength.
Six years prior, she had undergone an anterior cervical disc replacement at C5-C6, which initially provided complete symptom relief. However, over the past year, her symptoms gradually returned. Her surgeon’s updated imaging revealed a small anterior migration of the cervical disc prosthesis. Additionally, her specific disc implant had been recalled by the FDA due to a design flaw associated with an increased risk of migration and long-term instability.
The surgeon discussed the option of revision surgery, converting the disc replacement to a fusion procedure. However, the patient expressed a strong desire to avoid further surgery unless absolutely necessary, citing prior recovery challenges and concerns over long-term spinal mobility.
Clinical Evaluation
The patient was alert and cooperative. Her cervical pain rated 8/10, and her cervical Functional Rating Index was 67.5%. Cervical range of motion was moderately restricted, especially in flexion and left rotation, both of which reproduced her neck pain. Palpation revealed segmental pain at the lower cervical paraspinal muscles, with notable hypertonicity in the left levator scapulae and upper trapezius. The thoracic spine was restricted on motion.
A neurologic exam was normal, including upper-extremity strength (5/5), reflexes and sensory responses. Spurling’s maneuver mildly increased neck pain but did not produce arm symptoms.
The patient’s physical performance test demonstrated poor endurance and weakness in the deep cervical flexors and stabilizing musculature. This indicated significant deconditioning of the cervical support system.
A review of the imaging confirmed a minor anterior migration of the prosthesis at C5-C6, but no signs of cord compression, severe stenosis or gross instability.
Clinical Decision-Making
Given the device recall and implant migration, direct cervical manipulation was contraindicated. Thoracic stiffness and upper thoracic compensation patterns were contributing to her cervical stress.
We explained the risks, benefits, and limitations of care, including the FDA recall, imaging findings, and avoidance of direct cervical manipulation techniques. The patient consented to a conservative plan focusing on thoracic manipulation, cervical soft-tissue therapy, retraining of the cervical-thoracic muscles, and cautious observation, with regular re-evaluation by the surgical team.2,4-5
Treatment and Outcome
Initial care included thoracic spine manipulation, gentle myofascial release of the sternocleidomastoideus, upper trapezius and levator scapulae, and instruction in deep cervical flexor endurance exercises (e.g., isometric holds).
After the first treatment, the patient reported immediate reduction in pain and tightness. Over the next month, she attended 11 additional visits, each combining thoracic manipulation, soft-tissue work and progressive rehabilitation exercises for the cervical musculature.
On the 11th visit, she reported an 80% improvement in pain, increased cervical ROM and significantly less fatigue with daily activities. She also reported better sleep and decreased reliance on NSAIDs.
Discussion
This case highlights the role of chiropractors in managing complex postsurgical patients, particularly those with recalled spinal implants.
The patient’s case also emphasizes the need for collaborative care. The decision to proceed conservatively was supported by the surgeon and enabled the patient to avoid revision surgery at the present time while making meaningful functional gains.
References
- Ansley B, Koreckij T, Jin A, et al. Ten-year risk of recall of novel spine devices. Spine, 2024;49:E361-E366.
- de Campos TF, Maher C, Steffens D, et al. Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. J Physiother, 2018;64:159-165.
- Dykhouse GL, Bratescu RA, Kashlan ON, et al. Trends in spinal implant utilization and pricing. J Craniovertebr Junction Spine, 2024;15:404-410.
- Overmann L, Schleip R, Anheyer D, Michalak J. Myofascial release for adults with chronic neck pain and depression. Acta Psychol, 2024;247:104325.
- Young IA, Pozzi F, Dunning J, et al. Immediate and short-term effects of thoracic spine manipulation in patients with cervical radiculopathy: a randomized controlled trial. J Orthop Sports Phys Ther, 2019;49:299-309.
