Total Disc Replacement Complications

Cervical arthroplasty, a surgical intervention for cervical spine issues, can be associated with complications stemming from patient selection and surgical technique. Certain patients with specific conditions may not be appropriate candidates for the procedure and may experience complications.

Errors during surgery can lead to problems such as implant sinking, implant dislodgement, nerve-related symptoms, spinal curvature, and abnormal bone growth. This article focuses on the unique complications of cervical arthroplasty and provides a comparison of these complications between cervical total disc replacement (cTDR) and anterior cervical discectomy and fusion (ACDF) procedures.

Implant Sinking, Dislodgment, Displacement, And Bone Loss

Possible complications of cervical arthroplasty include implant sinking (subsidence), implant movement or dislocation, persistent nerve root symptoms (residual radiculopathy), and rare cases of osteolysis.

Subsidence can lead to neck pain and nerve compression, and its occurrence rates vary in the available literature. Patients with osteopenia or osteoporosis have a higher risk. Suboptimal surgical techniques like violating the end plates or using undersized implants can contribute to subsidence.

Insufficient decompression during the procedure can result in ongoing radicular symptoms. Osteolysis, although uncommon, can arise from wear debris or an immune response, especially when metal-on-metal devices are used.

Addressing complications such as subsidence, expulsion, dislocation, and osteolysis usually involves undergoing revision surgery with anterior approaches, where the device is removed and converted to fusion, either through ACDF or anterior corpectomy.

On the other hand, recurrent radiculopathy caused by recurrent or residual foraminal stenosis can typically be treated with a posterior minimally invasive laminoforaminotomy. This procedure is also minimally invasive and preserves motion.

Heterotopic Ossification

Heterotopic ossification (HO) is characterized by the abnormal formation of bone outside the skeletal system, which can arise as a complication after arthroplasty procedures.

This condition can lead to restricted joint movement and, in some cases, fusion of the affected joint. Various risk factors have been identified, including advanced spondylosis, osteophytic disease, male gender, and older age. To minimize the occurrence of HO, it is crucial to undertake careful patient selection, employ precise surgical techniques, and ensure the use of appropriately sized implants.

When selecting patients for arthroplasty, it is important to consider the presence of risk factors that may predispose individuals to develop HO. Surgeons should follow meticulous surgical techniques, which involve thorough irrigation during drilling and the use of bone wax when necessary to prevent exposure of cancellous bone.

Optimal implant sizing is also important, as choosing implants that adequately cover the end plates can help reduce the risk of HO. It is noteworthy that HO typically does not produce noticeable symptoms, thereby rendering revision surgery unnecessary in most cases. Instead, the focus lies on implementing preventive measures and closely monitoring patients for any potential complications associated with HO.

Adjacent Segment Disease

Adjacent segment disease is characterized by degenerative changes in spinal segments adjacent to a previously fused spinal level. It can cause symptoms like radiculopathy, myelopathy, or mechanical instability.

The introduction of motion-preserving devices aimed to reduce stress on adjacent segments, potentially decreasing the occurrence of adjacent segment disease compared to fusion. However, the development of this condition is influenced by various factors, including the underlying degenerative process, patient selection, surgical technique, and the number of levels treated.

While arthroplasty may show promise in reducing adjacent-level degeneration and disease compared to fusion, further research is necessary to gain a comprehensive understanding of its effectiveness.

Research conducted on cadavers has shown that artificial disc placement decreases stress on neighboring segments in comparison to simulated fusion. Initial findings from studies examining adjacent segment degeneration after artificial disc replacement revealed no signs of degeneration during a 5-year follow-up.

A meta-analysis involving FDA Investigational Device Exemption (IDE) studies, which encompassed three randomized multicenter trials, exhibited a notably reduced incidence of adjacent-level surgery favoring arthroplasty.

Supporting evidence from a thorough meta-analysis further confirmed the lower occurrence of adjacent segment degeneration and reoperation in favor of arthroplasty. Long-term studies with follow-up durations of up to 84 months have demonstrated the potential for reduced rates of adjacent-level degeneration and reoperation with arthroplasty.

For instance, a study involving the SECURE-C device revealed a significantly lower incidence of adjacent segment reoperation in the arthroplasty group compared to the anterior cervical discectomy and fusion (ACDF) group.

Likewise, investigations involving the Prestige ST Disc and Mobi-C device have shown decreased incidences of adjacent segment degeneration and subsequent surgeries in the arthroplasty groups compared to ACDF.

These results provide further evidence supporting the idea that arthroplasty may be linked to a decreased risk of adjacent segment degeneration and the requirement for additional surgical interventions, both at the treated level and neighboring segments.


Dysphagia, characterized by difficulty swallowing, is a frequent complication that can arise after anterior cervical surgery. While the precise causes remain unclear, they are likely influenced by multiple factors.

Age, duration of degenerative disease, operative time, blood loss, multilevel surgery, diabetes, and smoking have been identified as predictors of dysphagia. Immediately after surgery, dysphagia rates are typically high, with no significant disparity observed between cervical arthroplasty and anterior cervical discectomy and fusion (ACDF) in most studies.

However, some studies indicate a potentially lower occurrence of dysphagia with arthroplasty. A meta-analysis concluded that ACDF does not demonstrate superiority over arthroplasty across various outcome measures.

To minimize the likelihood of dysphagia during anterior cervical exposure, it is advised to utilize well-established techniques. These strategies involve ensuring careful control of bleeding, positioning retractors in the longus colli muscles and periodically releasing them every 15 to 20 minutes, conducting thorough release of muscles and soft tissues during dissection (including potential removal of the omohyoid muscle), deflating the endotracheal cuff after retractor placement, maintaining adequate blood flow in the superficial temporal artery following retraction, and administering corticosteroids perioperatively.

Complications Related to Blood Vessels and Risk of Infection

Adverse vascular events and surgical site infections are infrequent in anterior cervical surgery. Comparisons between arthroplasty and anterior cervical discectomy and fusion (ACDF) have shown minimal blood loss with no substantial disparity between the two procedures.

Although isolated cases of intraoperative vascular injuries have been reported, the overall incidence of surgical site infections remains minimal. Consistent findings across various studies comparing arthroplasty and ACDF have highlighted low rates of vascular events and infections.

Dysphagia, the most common complication, is not associated with a higher risk in arthroplasty compared to anterior cervical discectomy and fusion (ACDF). Complications related to the anterior cervical approach are infrequent and display similar occurrence rates in both ACDF and cervical total disc replacement (cTDR). Rates of vascular complications and infection are low, with no significant differences observed between ACDF and arthroplasty.

Precise patient selection and surgical technique can help mitigate complications associated with cervical artificial disc placement, such as subsidence, displacement, osteolysis, and heterotopic ossification (HO), although these occurrences are rare. Cervical arthroplasty is most suitable for patients with 1- to 2-level cervical soft disc disease, mild spondylosis, and no significant facet disease or osteoporosis.

Surgical techniques may vary depending on the chosen implant, but they typically involve accurate midline verification, symmetrical decompression with resection of the proximal uncovertebral joint, minimal drilling, preservation of the bony end plates, appropriate implant sizing, and placement close to the disc’s natural center of rotation. In the event of failed cervical disc arthroplasty, revision surgery is typically straightforward and tailored to address the specific cause of failure.

The development of adjacent segment disease can be observed after arthroplasty or arthrodesis surgeries, and it is influenced by various factors. Biomechanical research has demonstrated that artificial disc placement decreases the stress on neighboring levels in comparison to fusion.

The clinical significance of these reduced stresses is still a matter of discussion. Nevertheless, several meta-analyses and long-term studies indicate that cervical arthroplasty might be associated with a lower occurrence of adjacent segment degeneration and disease.

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Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
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20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
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23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
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00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
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23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
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03:25 09 Apr 22
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Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
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14:53 03 Mar 22
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Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
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Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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