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No device was able to be evaluated as it remains in-situ.The radiographs provided were reviewed but the reported subsidence was unable to be confirmed as no apparent differences in implant position could be seen between the immediate post-op and three-month post-operative images.Information regarding the patient's bone quality/bone density was not provided for review.A review of manufacturing records was unable to be performed as the part and lot information of the product involved in the event was not available.Based on the information obtained, a definitive root cause was unable to be determined.Labeling review: "¿contraindications: simplify cervical artificial disc should not be implanted in patients with the following conditions: osteoporosis or osteopenia defined as dexa bone mineral density t-score less than -1.5." ".Warnings: simplify cervical artificial disc should only be used by surgeons who are experienced with anterior cervical spinal procedures and have undergone hands-on training in the use of this device.Only surgeons who are familiar with simplify cervical artificial disc components, instruments, procedure, clinical applications, biomechanics, adverse events (aes), and risks associated with simplify cervical artificial disc should use this device.A lack of adequate experience and/or training may lead to a higher incidence of aes, including neurological complications.Correct selection of the appropriate implant size and correct placement of simplify cervical artificial disc are essential to ensure proper performance and functioning of the device." ".Preoperative: in order to minimize the risk of atraumatic periprosthetic vertebral fractures, surgeons must consider all comorbidities, past and present medications, previous treatments, etc.Upon reviewing all relevant information, the surgeon must determine whether a bone density (dexa) scan is prudent.If dexa is performed, the patient should not receive the device if the dexa bone mineral density t-score is <-1.5, as the patient may be osteoporotic or osteopenic." ".Intraoperative: take care not to over-distract the disc space.Excessive removal of endplate cortical bone may result in sub-optimal outcomes." ".Postoperative: patients should be instructed in postoperative care procedures and should be advised of the importance of adhering to these procedures for successful treatment with the device.Heavy lifting (greater than 20lbs) should be avoided for 6 weeks, and impact sports should be avoided for 3 months." ".Cervical artificial disc risks: risks specific to cervical artificial discs, including the simplify cervical artificial disc, are but may not be limited to: device migration, device subsidence.Excessive device height loss.Disc space collapse.Additional surgery due to loss of fixation, infection or injury.Removal, revision, reoperation or supplemental fixation of the disc." if any further information is obtained that would change or alter any information provided, a supplemental report will be filed accordingly.
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