Wu Ting-Kui, Liu Hao, Wang Bei-Yu, He Jun-Bo, Ding Chen, Rong Xin, Yang Yi, Huang Kang-Kang, Hong Ying
Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
Department of Operating Room, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
Spine J. 2020 Aug;20(8):1219-1228. doi: 10.1016/j.spinee.2020.05.102. Epub 2020 May 20.
The development of bone loss (BL) at the operated level after cervical disc arthroplasty (CDA) has not been well recognized. The incidence of BL may be correlated with the prosthesis type. Currently, no study has reported the incidence of BL after CDA with the Prestige-LP disc, and this remains an active area of research.
To determine the incidence of BL after Prestige-LP CDA and evaluate the impact of BL on clinical and radiological outcomes.
This is an observational study.
A total of 396 patients were reviewed.
The Japanese Orthopedics Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI) scores were evaluated. Cervical lordosis, disc angle, global and segmental range of motion (ROM), heterotopic ossification (HO), and BL were measured.
We retrospectively reviewed patients who underwent Prestige-LP disc from January 2008 to October 2018 at our institution. Clinical outcomes were evaluated using JOA, VAS, and NDI scores. Radiological variables, including cervical lordosis, disc angle, global and segmental ROM, HO, and BL, were retrieved.
A total of 396 patients and 483 CDAs were evaluated. BL occurred in 56.6% of patients and 52.8% of CDA segments. Mild BL occurred in 30.2%, moderate BL in 37.3%, and severe BL in 32.5% of CDA segments. Notably, 88.2% of CDA segments developed BL within the first 3 months, and 19.1% of them progressed at 6 months. However, no progressive BL after 12 months was seen. About 50.2% of CDAs showed superior and inferior endplates involvement. The incidence of BL was associated with age, surgery type, level distribution, and incidence and grade of HO. Patients with BL had a better segmental ROM, but no relationships between patients with or without BL were found in clinical outcomes.
BL was a common but self-limited phenomenon after CDA at the early postoperative stage. It occurred more often in relatively young age patients, two-level CDA, and C5/6 segment. However, patients suffering from BL showed no deterioration of the clinical outcomes, more exceptional motion preservation at the arthroplasty level, and lower incidence with a lower grade of HO.
颈椎间盘置换术（CDA）后手术节段骨丢失（BL）的发生情况尚未得到充分认识。骨丢失的发生率可能与假体类型相关。目前，尚无研究报道使用Prestige-LP椎间盘进行CDA后的骨丢失发生率，这仍是一个活跃的研究领域。
确定Prestige-LP CDA后骨丢失的发生率，并评估骨丢失对临床和影像学结果的影响。
这是一项观察性研究。
共纳入396例患者进行回顾性分析。
评估日本骨科协会（JOA）评分、视觉模拟量表（VAS）评分和颈部功能障碍指数（NDI）评分。测量颈椎前凸、椎间盘角度、整体和节段活动度（ROM）、异位骨化（HO）和骨丢失情况。
我们回顾性分析了2008年1月至2018年10月在我院接受Prestige-LP椎间盘置换术的患者。使用JOA、VAS和NDI评分评估临床结果。收集包括颈椎前凸、椎间盘角度、整体和节段ROM、HO和骨丢失等影像学变量。
共评估了396例患者和483个CDA节段。56.6%的患者和52.8%的CDA节段发生了骨丢失。轻度骨丢失发生在30.2%的CDA节段，中度骨丢失发生在37.3%的CDA节段，重度骨丢失发生在32.5%的CDA节段。值得注意的是，88.2%的CDA节段在术后3个月内出现骨丢失，其中19.1%在6个月时进展。然而，12个月后未见进行性骨丢失。约50.2%的CDA节段显示上下终板受累。骨丢失的发生率与年龄、手术类型、节段分布以及HO的发生率和分级有关。发生骨丢失的患者节段活动度较好，但在临床结果方面，骨丢失患者与未发生骨丢失患者之间未发现差异。
骨丢失是CDA术后早期常见但自限性的现象。在相对年轻的患者、双节段CDA和C5/6节段中更常发生。然而，发生骨丢失的患者临床结果并未恶化，在置换节段有更优异的活动度保留，且HO发生率更低、分级更低。
