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人工颈椎间盘置换术后的骨质溶解

Osteolysis after cervical disc arthroplasty with artificial cervical disc.

作者信息

Silva Tavares Joana Margarida, Jácome Morgado Diogo Maria, Seromenho Santos Nora Alexandra, Lopes Luís Ana Isabel

机构信息

Neurosurgery Department , Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal.

Hospital da Luz, Lisbon, Portugal.

出版信息

Eur Spine J. 2025 Jan;34(1):64-68. doi: 10.1007/s00586-024-08585-z. Epub 2024 Dec 3.

DOI:10.1007/s00586-024-08585-z
PMID:39625657
Abstract

PURPOSE

Cervical total disc arthroplasty (TDA) is a motion-preserving alternative to anterior cervical discectomy and fusion that has gained popularity among spine surgeons. Although generally effective, TDA has been associated with rare cases of progressive osteolysis, a complication whose natural history and impact on clinical outcomes are not well understood. This case report aims to present a case of progressive osteolysis following cervical TDA with the SpinalKinetics M6-C Artificial Cervical Disc and to discuss the clinical approach and implications for patient management.

METHODS

We reviewed the clinical course of a patient who underwent cervical TDA with the SpinalKinetics M6-C Artificial Cervical Disc and subsequently developed progressive osteolysis. The patient's symptoms, diagnostic findings, and treatment progression were documented, with a focus on the timing of symptom onset, imaging, and the therapeutic interventions applied.

RESULTS

The patient demonstrated a delayed onset of symptoms related to osteolysis, which was identified through CT imaging as a progressive complication. The slow progression of osteolysis in this case underscores the need for careful monitoring, as early symptoms may be subtle but can lead to significant clinical implications if unaddressed.

CONCLUSION

This case highlights the potential for progressive osteolysis as a complication following cervical TDA, emphasizing the importance of ongoing surveillance and increased awareness among spine surgeons. Early identification and monitoring of osteolysis may mitigate the risk of severe outcomes and guide timely intervention.

摘要

目的

颈椎全椎间盘置换术(TDA)是一种保留运动功能的手术,可替代颈椎前路椎间盘切除融合术,在脊柱外科医生中越来越受欢迎。尽管TDA总体上有效,但它与罕见的进行性骨质溶解病例有关,这种并发症的自然病程及其对临床结果的影响尚不清楚。本病例报告旨在介绍一例使用SpinalKinetics M6-C人工颈椎间盘进行颈椎TDA术后发生进行性骨质溶解的病例,并讨论临床处理方法及对患者管理的意义。

方法

我们回顾了一名接受SpinalKinetics M6-C人工颈椎间盘颈椎TDA手术并随后发生进行性骨质溶解患者的临床病程。记录了患者的症状、诊断结果和治疗过程,重点关注症状出现的时间、影像学检查以及所采取的治疗干预措施。

结果

患者出现与骨质溶解相关的症状较晚,通过CT成像确定为一种进行性并发症。本病例中骨质溶解进展缓慢,这凸显了仔细监测的必要性,因为早期症状可能不明显,但如果不加以处理可能会导致严重的临床后果。

结论

本病例突出了颈椎TDA术后发生进行性骨质溶解作为一种并发症的可能性,强调了持续监测的重要性以及脊柱外科医生提高认识的必要性。早期识别和监测骨质溶解可能会降低严重后果的风险并指导及时干预。

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本文引用的文献

1
Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris.中期骨溶解导致 M6-C™颈椎间盘置换术后无菌性失败,原因是聚乙烯磨损颗粒。
Eur Spine J. 2022 May;31(5):1273-1282. doi: 10.1007/s00586-021-07094-7. Epub 2022 Jan 12.
2
Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty.颈椎间盘置换术后相邻节段和索引节段的影像学变化。
Yonsei Med J. 2022 Jan;63(1):72-81. doi: 10.3349/ymj.2022.63.1.72.
3
Anterior bone loss after cervical disc replacement: A systematic review.
颈椎间盘置换术后的前方骨质流失:一项系统评价。
World J Clin Cases. 2020 Nov 6;8(21):5284-5295. doi: 10.12998/wjcc.v8.i21.5284.
4
Granulomatous Reaction on a Double-Level Cervical Total Disc Arthroplasty.双节段颈椎全椎间盘置换术后的肉芽肿反应
World Neurosurg. 2019 Feb;122:360-363. doi: 10.1016/j.wneu.2018.11.070. Epub 2018 Nov 17.