Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China.
Eur Spine J. 2024 Oct;33(10):3969-3977. doi: 10.1007/s00586-024-08400-9. Epub 2024 Jul 20.
Cervical disc arthroplasty (CDA) is widely employed for patients diagnosed with cervical degenerative disc disease (CDDD). Postoperative bone loss (BL) represents a radiological alteration that is a relatively novel consideration in the realm of CDA. This study endeavors to examine the risk factors associated with BL following CDA, aiming to elucidate the underlying mechanisms and the impact of BL on surgical outcomes.
A retrospective study was undertaken, encompassing consecutive patients subjected to one-level CDA, two-level CDA, or two-level hybrid surgery (HS) for the treatment of CDDD at our institution. Patient demographic and perioperative data were systematically recorded. Radiological images obtained preoperatively, at 1-week post-operation, and during the last follow-up were collected and evaluated, following with statistical analyses.
A total of 295 patients and 351 arthroplasty segments were involved in this study. Univariate logistic regressions indicated that age ≥ 45 years and two-level HS was associated with lower risk of BL; and a greater ΔDA (change of disc angle before and after surgery) was correlated with an increased risk of BL. Multivariate logistic regression determined that two-level HS and greater ΔDA were independent preventative and risk factors for BL, respectively. Further analysis revealed that severe BL significantly elevated the risk of implant subsidence compared to non-BL and mild BL.
This study posited bone remodeling and micromotion as potential underlying mechanisms of BL. Subsequent research endeavors should delve into the divergent mechanisms and progression observed between lower- and higher-grade BL, aiming to prevent potential adverse outcomes associated with severe BL.
颈椎间盘置换术（CDA）广泛应用于诊断为颈椎退行性椎间盘疾病（CDDD）的患者。术后骨丢失（BL）是 CDA 领域中一个相对较新的考虑因素，代表一种影像学改变。本研究旨在探讨 CDA 后 BL 的相关危险因素，旨在阐明 BL 的潜在机制及其对手术结果的影响。
本研究采用回顾性研究，纳入在我院接受单节段 CDA、双节段 CDA 或双节段混合手术（HS）治疗 CDDD 的连续患者。系统记录患者的人口统计学和围手术期数据。收集并评估术前、术后 1 周和最后一次随访时获得的影像学图像，并进行统计学分析。
本研究共纳入 295 例患者和 351 个节段。单变量逻辑回归表明，年龄≥45 岁和双节段 HS 与 BL 风险较低相关；而较大的 ΔDA（手术前后椎间盘角度的变化）与 BL 风险增加相关。多变量逻辑回归确定双节段 HS 和较大的 ΔDA 分别是 BL 的独立预防和危险因素。进一步分析表明，与非 BL 和轻度 BL 相比，严重 BL 显著增加了植入物沉降的风险。
本研究提出骨重塑和微动可能是 BL 的潜在机制。未来的研究应深入探讨低级别和高级别 BL 之间观察到的不同机制和进展，旨在预防与严重 BL 相关的潜在不良后果。
