Performance of Cervical Arthroplasty at a Pseudarthrosed Level of a MultiLevel Anterior Cervical Discectomy and Fusion: Case Report

OBJECTIVE: To present a conversion from an anterior cervical discectomy and fusion (ACDF) to cervical arthroplasty in a 40-year-old, active duty member and perform a review of the literature. METHODS: A helicopter pilot in the U.S. Army underwent a three-level ACDF in 2010 at a nonmilitary institution for symptoms of bilateral upper-extremity radiculopathy. His symptoms resolved; however, per regulations, he was grounded. The patient recently presented at our clinic for evaluation of axial neck and intrascapular pain with radiographic evaluation revealing pseudarthrosis at C6-7 with segmental motion without facet joint degeneration. Surgery was performed to remove the existing allograft and replace it with an artificial disc, thus restoring a motion segment. RESULTS: Postoperative imaging reveals appropriate placement of the artificial disc and range of motion at C6-7 with the patient reporting improvement in neck pain. He has since been granted a waiver to return to active flight status. CONCLUSIONS: Revision of ACDF to arthroplasty is an exceedingly rare procedure with only two cases reported in the literature. Here, the authors demonstrate use of the procedure for a military career-specific application. When facet joint degeneration or ankylosis is absent, restoration of motion can successfully, and safely, be achieved.