Cervical DISH, is there any place for multilevel cervical arthroplasty? A case report metal-on-metal two-level cervical disc arthroplasty with 2-year follow-up and quality of life assessment

Introduction and importance: Cervical diffuse idiopathic skeletal hyperostosis (DISH) can cause stiffness, reducing quality of life as the result of functional impairment and progressive pain. The standard treatment depends on patient’s problem which often involves anterior cervical discectomy and function, but this approach can lead to ASD. Cervical disc arthroplasty (CDA) using a metal-on-metal (MoM) prosthesis may offer an alternative treatment to preserve segmental motion while alleviating symptoms. Case presentation: A 55-year-old man presented with progressive cervical stiffness and pain, which reduced his quality of life and worsened in the past 2 years. The lateral cervical radiograph revealed ossification of the anterior longitudinal ligament in the anterolateral area from C2 until C7. The CT scan showed ossification from C2 to T6. Attempted conservative treatment had failed. The patient underwent two-level CDA MoM at C4-5 and C5-6. Clinical discussion: The patient experienced significant improvements in pain (VAS reduced from 5/10 to 0/10). At the 12- and 24- month postoperative follow-ups, there is an improvement in the Neck Disability Index (NDI) and SF-36 score. Clinical function (by NDI) and the physical and mental components of SF-36 were parameters with significant improvement, which led to patient satisfaction. No implant-related complications or ASD were observed at the 2-year follow-up. Conclusion: This case highlights the potential benefits of MoM two-level CDA for selected DISH patients with degenerative disc disease. The procedure preserved mobility, reduced pain, and improved quality of life without ASD. Further studies are needed to evaluate long-term outcomes.