Cervical Disc ArthroplastyThe London Spine Unit : most established day surgery spinal centre in UKPublished articleCONCLUSIONS: Non-progressive, early onset bone loss is a common finding after CDA and typically does not affect the reported short-term pain scores or lead to early revision. By contrast, osteolysis was less common, presenting more than a year post-operative and often accompanied by additional complications, leading to revision surgery. A greater understanding of the clinical significance is limited by the lack of long-term studies, inconsistent terminology, and infrequent use of histology and…Cervical Disc Arthroplasty Expert. Best Spinal Surgeon UKThe London Spine Unit is a specialist clinic for Cervical Disc Arthoplasty as Day Surgery.
Abstract
Methods: A systematic review of the literature was conducted following PRISMA guidelines, using the keywords “cervical,” “disc replacement,” “osteolysis,” “bone loss,” “radiograph,” and “complications.” A total of 23 articles met the inclusion criteria with the majority being retrospective or case reports.
Results: Fourteen studies reported periprosthetic osteolysis in a total of 46 patients with onset ranging from 15-96 months after the index procedure. Reported causes included: metal hypersensitivity, infection, mechanical failure, and wear debris. Osteolysis was generally progressive and led to reoperation. Nine articles reported non-inflammatory bone loss in 527 patients (52.5%), typically within 3-6 months following implantation. The reported causes included: micromotion, stress shielding, and interrupted blood supply. With one exception, bone loss was reported to be non-progressive and had no effect on clinical outcome measures.
Conclusions: Non-progressive, early onset bone loss is a common finding after CDA and typically does not affect the reported short-term pain scores or lead to early revision. By contrast, osteolysis was less common, presenting more than a year post-operative and often accompanied by additional complications, leading to revision surgery. A greater understanding of the clinical significance is limited by the lack of long-term studies, inconsistent terminology, and infrequent use of histology and explant analyses. Uniform reporting and adoption of consistent terminology can mitigate some of these limitations. Executing these actionable items is critical to assess device performance and the risk of revision.
Level of evidence iv: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Keywords: Bone loss; Cervical disc replacement; Osteolysis; Periprosthetic bone changes; Radiographic outcome.
The London Spine Unit : most established day surgery spinal centre in UKRead the original publication from Pubmed : The lexicon for periprosthetic bone loss versus osteolysis after cervical disc arthroplasty: a systematic review