Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Spine (Phila Pa 1976). 2011 Jun 15;36(14):E973-8. doi: 10.1097/BRS.0b013e3181fd863b.
Case report.
To review the management of a patient with progressive osteolysis of the vertebral body after undergoing cervical arthroplasty for management of a refractory radiculopathy.
Since the Food and Drug Administration's (FDA) approval of cervical arthroplasty devices in 2007, many surgeons have incorporated this technology into clinical practice. As arthroplasty becomes more widespread, complications unique to this technology are inevitable. To date, only a limited number of complications have been reported in the literature suggesting the safety of this device. To the authors' knowledge, this report represents the first complication of osteolysis from a keel based arthroplasty device.
A 30-year-old man underwent an uneventful C5-C6 total disc arthroplasty with initial benefit. Progressively worsening neck pain prompted repeat imaging at 9 and 15 months, which showed a progressive osteolytic process in the vicinity of the keel of the superior alloy endplate. This necessitated exploration of the surgical site, explantation of the implant and conversion of the disc arthroplasty to an arthrodesis.
Examination of the osteolytic area did not reveal any gross abnormalities. Testing of the device by the manufacturer did not reveal any defects. A comprehensive infectious workup was negative. The osteolytic process halted after the explantation of the device. A bony arthrodesis was achieved at 6 months and the patient remains symptom free 29 months after the initial procedure and 14 months after the revision.
This report illustrates an exceptional case of a progressive osteolysis with a keel based arthroplasty device. An immune mediated osteolytic process appears to be a plausible explanation for the clinical symptoms and radiographic progression seen in this case. Given the years of use of the ProDisc-C since its FDA approval in 2007, complications with this device are rare. This represents the first reported case of osteolysis from such an implant.
病例报告。
回顾颈椎置换术后因难治性神经根病而行颈椎关节成形术的患者发生椎体进行性溶骨的治疗管理。
自 2007 年美国食品和药物管理局（FDA）批准颈椎关节成形术设备以来，许多外科医生已将该技术纳入临床实践。随着关节成形术的普及，该技术不可避免地会出现独特的并发症。迄今为止，文献中仅报道了有限数量的表明该设备安全性的并发症。据作者所知，该报告代表了首例基于龙骨的关节成形术设备的溶骨并发症。
一名 30 岁男性行 C5-C6 全椎间盘关节成形术，手术过程顺利，术后早期获益。逐渐加重的颈部疼痛促使患者在 9 个月和 15 个月时进行重复影像学检查，显示龙骨上合金端板附近出现进行性溶骨过程。这需要探查手术部位，取出植入物，并将椎间盘关节成形术转换为关节融合术。
对溶骨区域的检查未发现任何明显异常。制造商对设备的测试未发现任何缺陷。全面的感染性检查均为阴性。在取出设备后，溶骨过程停止。6 个月后实现了骨性融合，患者在初始手术 29 个月后和翻修手术后 14 个月后仍无症状。
本报告说明了一例罕见的龙骨基关节成形术设备进行性溶骨的病例。免疫介导的溶骨过程似乎是该病例中所见的临床症状和影像学进展的合理解释。考虑到 ProDisc-C 自 2007 年获得 FDA 批准以来已经使用了多年，该设备的并发症很少见。这代表了首例此类植入物的溶骨报告。
