The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance With UCLA, 403 W. Adams Blvd, Los Angeles, CA, 90007, USA.
Department of Bioengineering, University of California, Los Angeles, CA, USA.
Eur Spine J. 2022 Apr;31(4):830-842. doi: 10.1007/s00586-021-07092-9. Epub 2022 Jan 9.
Periprosthetic bone loss is a common observation following arthroplasty. Recognizing and understanding the nature of bone loss is vital as it determines the subsequent performance of the device and the overall outcome. Despite its significance, the term "bone loss" is often misused to describe inflammatory osteolysis, a complication with vastly different clinical outcomes and treatment plans. Therefore, the goal of this review was to report major findings related to vertebral radiographic bone changes around cervical disc replacements, mitigate discrepancies in clinical reports by introducing uniform terminology to the field, and establish a precedence that can be used to identify the important nuances between these distinct complications.
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.
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.
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.
Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
假体周围骨丢失是关节置换术后的常见现象。认识和理解骨丢失的性质至关重要，因为它决定了器械的后续性能和整体结果。尽管其意义重大，但“骨丢失”一词经常被误用，来描述炎症性骨溶解，这是一种具有截然不同的临床结果和治疗方案的并发症。因此，本综述的目的是报告与颈椎间盘置换相关的颈椎放射性骨改变的主要发现，通过向该领域引入统一的术语来减少临床报告中的差异，并建立一个先例，以确定这些不同并发症之间的重要细微差别。
按照 PRISMA 指南进行文献系统综述，使用关键词“颈椎”、“椎间盘置换”、“骨溶解”、“骨丢失”、“射线照相”和“并发症”。共有 23 篇文章符合纳入标准，其中大多数为回顾性或病例报告。
14 项研究共报告了 46 例假体周围骨溶解，发病时间为指数手术后 15-96 个月。报告的原因包括：金属过敏、感染、机械故障和磨损颗粒。骨溶解通常是进行性的，并导致再次手术。9 篇文章报告了 527 例非炎症性骨丢失（52.5%），通常在植入后 3-6 个月内发生。报告的原因包括：微动、应力屏蔽和血液供应中断。除一例外，骨丢失被报告为非进行性，对临床结果测量没有影响。
非进行性、早期发生的骨丢失是 CDA 后的常见发现，通常不会影响报告的短期疼痛评分，也不会导致早期翻修。相比之下，骨溶解较为少见，发生在术后一年以上，常伴有其他并发症，导致翻修手术。由于缺乏长期研究、术语不一致以及组织学和植入物分析的使用不频繁，对其临床意义的理解受到限制。统一报告和采用一致的术语可以减轻其中的一些限制。执行这些可操作的项目对于评估器械性能和翻修风险至关重要。
证据等级 IV：诊断：个体横断面研究，具有一致的参考标准和盲法。
