J Korean Neurosurg Soc.  2023 Sep;66(5):591-597. 10.3340/jkns.2022.0190.

Cervical Myelopathy Induced by Posterior Vertebral Body Osteolysis after Cervical Disc Arthroplasty

• Choi MK
• Lee JH

• KMID: 2545350
• DOI: http://doi.org/10.3340/jkns.2022.0190

Abstract

Cervical disc arthroplasty (CDA) has become more widespread and diverges from the conventional technique used in anterior cervical fusion for cervical degenerative disc disease. As arthroplasty has become a popular treatment option, few complications have been reported in the literature. These include subsidence, expulsion, posterior avulsion fractures, heterotopic ossification, and osteolysis. One of the critical complications is osteolysis, but current studies on this subject are limited in terms of not elucidating the incidence, etiology, and consequences. The authors present two cases, who presented with clinical signs of gradually worsening myelopathy induced by posterior vertebral body osteolysis, 2 years after CDA. Subsequently, the patient underwent posterior decompression and fusion without prosthesis removal. Postoperatively, the clinical symptoms gradually resolved, with no severe deficits. The present rare cases highlight the osteolysis that occurs after CDA, which can cause cervical myelopathy, and suggest spine surgeons to be alert to this fatal complication.

Keyword

Arthroplasty; Cervical vertebrae; Myelopathy; Osteolysis

Figure

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  Fig. 1. Pre-operative T2-weighted magnetic resonance imaging with definite evidence of foraminal stenosis and herniated intervertebral disc. Sagittal image (A) and axial image at C4-5 (B) and C5-6 (C). The three-dimensional reconstructed coronal (D) and sagittal (E) scans by cervical spine computed tomography obtained immediately after surgery. This view shows no lucency and bony destruction around the prosthesis.

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  Fig. 2. Magnetic resonance imaging sagittal, axial (A and B) and computed tomography (C) scans obtained 25 months after surgery. A lucency was seen surrounding the posterior margin of the endplates at the C4-5-6 levels (arrows). Red dotted line showed cord signal change. Plain radiographs. Lateral (D) views of cervical spine at 12 months after revision surgery showing stoppage of the osteolytic process and stable structure.

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  Fig. 3. Pre-operative axial image of magnetic resonance imaging (A). Plain radiographs. Anteroposterior (B) and lateral (C) views of cervical spine immediately after surgery. These views show no lucency and bony destruction around the prosthesis.

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  Fig. 4. Magnetic resonance imaging (MRI) sagittal (A) and computed tomography (B) scans obtained 26 months after surgery. A lucency was seen surrounding the posterior margin of the endplates at the C5-6 level (arrow). Plain radiograph lateral (C) and MRI sagittal (D) views of cervical spine immediately after revision surgery.

Reference

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