Anterior Bone Loss in Cervical Disc Arthroplasty

Kieser, David Christopher; Cawley, Derek Thomas; Fujishiro, Takashi; Tavolaro, Celeste; Mazas, Simon; Boissiere, Louis; Obeid, Ibrahim; Pointillart, Vincent; Vital, Jean Marc; Gille, Olivier

Abstract

STUDY DESIGN: Retrospective, longitudinal observational study. PURPOSE: To describe the natural history of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and introduce a classification system for its assessment. OVERVIEW OF LITERATURE: ABL has recently been recognized as a complication of CDA, but its cause and clinical effects remain unknown.
METHODS
Patients with non-keeled CDA (146) were retrospectively reviewed. X-rays were examined at 6 weeks, 3, 6, 9, 12, 18, and 24 months, and annually thereafter for a minimum of 5 years. These were compared with the initial postoperative X-rays to determine the ABL. Visual Analog Scale pain scores were recorded at 3 months and 5 years. Neck Disability Index was recorded at postoperative 5 years. The natural history was determined and a classification system was introduced.
RESULTS
Complete radiological assessment was available for 114 patients with 156 cervical disc replacements (CDRs) and 309 endplates (average age, 45.3 years; minimum, 28 years; maximum, 65 years; 57% females). ABL occurred in 57.1% of CDRs (45.5% mild, 8.3% moderate, and 3.2% severe) and commenced within 3 months of the operation and followed a benign course, with improvement in the bone stock after initial bone resorption. There was no relationship between ABL degree and pain or functional outcome, and no implants were revised.
CONCLUSIONS
ABL is common (57.1%). It occurs at an early stage (within 3 months) and typically follows a non-progressive natural history with stable radiographic features after the first year. Most ABL cases are mild, but severe ABL occurs in approximately 3% of CDAs. ABL does not affect the patients' clinical outcome or the requirement for revision surgery. Surgeons should thus treat patients undergoing CDA considering ABL.