Analysis of infuence factors of anterior bone loss after cervical disc arthroplasty and its effect on effectiveness_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Tingkui ¹ , LIU Hao ¹ ,  WANG Beiyu ¹ , DING Chen ¹ , MENG Yang ¹ , RONG Xin ¹ , CHEN Hua ¹ , YANG Yi ¹ , HONG Ying ² , HUANG Kangkang ¹ , HE Junbo ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. West China School of Nursing, Sichuan University/Department of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

WANG Beiyu, Email: dove-baker@163.com

Keywords：

Cervical disc arthroplasty; anterior bone loss; osteolysis; bone remodeling; heterotopic ossification

DOI：

10.7507/1002-1892.202008126

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Objective To explore the influence factors of anterior bone loss (ABL) after cervical disc arthroplasty (CDA) and effects of ABL on the clinical and radiographic outcomes.Methods One hundred and fifty-five patients who underwent single-level Prestige-LP CDA between January 2008 and December 2017 and met the inclusive criteria were enrolled in the study. Perioperative data of patients were collected. The Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and the visual analogue scale (VAS) score were used for clinical outcomes evaluation. Radiographic parameters including cervical lordosis, C_2-7 range of motion (ROM), disc angle, segmental ROM, and the lengths of the upper and lower endplates were assessed on the X-ray films. Device-related complications, including ABL, subsidence, radiographic adjacent segment pathology, and heterotopic ossification, were recorded. Univariate analysis was used to analyze the related factors, and logistic regression analysis was used to screen the influence factors. Patients were grouped according to whether ABL occurred after operation, and the differences in clinical and imaging evaluation parameters were compared.Results There were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. Univariate analysis showed the significant differences in age, body mass index (BMI), and intraoperative blood loss between the two groups (P<0.05). However, there was no significant difference in gender, bone mineral density (T value), preoperative blood calcium level, preoperative blood phosphorus level, preoperative alkaline phosphatase level, operative segment, operative time, and follow-up time between the two groups (P>0.05). Multivariate analysis showed that the age and BMI were influence factors for ABL after CDA (P<0.05). The JOA score, NDI, and VAS score significantly improved in both groups at 3 months after operation (P<0.05), and the scores were further improved at last follow-up (P<0.05). There was no significant difference in JOA score, NDI, and VAS score between the two groups before and after operation (P>0.05). The preoperative cervical lordosis was significantly smaller in the ABL group than in the non-ABL group (t=−2.402, P=0.018). At last follow-up, the segmental ROM was significantly greater in the ABL group than in the non-ABL group (P<0.05), and the lengths of the upper and lower endplates were less in the ABL group than in the non-ABL group (P<0.05). No significant difference in the other radiographic parameters between the two groups were found (P>0.05). Prosthesis subsidence occurred in 5 cases (3.2%), including 3 cases in the ABL group and 2 cases in the non-ABL group; the difference between the two groups was not significant (P=1.000). Heterotopic ossification occurred in 67 cases (43.2%), including 32 cases in the ABL group and 35 cases in the non-ABL group; the difference between the two groups was significant (χ²=8.208, P=0.004). High-grade heterotopic ossification was detected in 26 cases (13 cases in the ABL group and 13 cases in the non-ABL group). Twenty-nine cases (18.7%) had radiographic adjacent segment pathology, including 15 cases in the ABL group and 14 cases in non-ABL group; the difference between the two groups was not significant (χ²=1.190, P=0.276).Conclusion The incidence of ABL after CDA was relatively high, which mainly occurred within 3 months after operation, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent influence factors for ABL. ABL does not affect the clinical outcomes but may preserve more ROM of prostheses.

Citation： WU Tingkui, LIU Hao, WANG Beiyu, DING Chen, MENG Yang, RONG Xin, CHEN Hua, YANG Yi, HONG Ying, HUANG Kangkang, HE Junbo. Analysis of infuence factors of anterior bone loss after cervical disc arthroplasty and its effect on effectiveness. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 26-32. doi: 10.7507/1002-1892.202008126 Copy

1.	Nunley PD, Kerr EJ, Cavanaugh DA, et al. Adjacent segment pathology after treatment with cervical disc arthroplasty or anterior cervical discectomy and fusion, part 2: clinical results at 7-year follow-up. Int J Spine Surg, 2020, 14(3): 278-285.
2.	Gornet MF, Burkus JK, Shaffrey ME, et al. Cervical disc arthroplasty: 10-year outcomes of the Prestige LP cervical disc at a single level. J Neurosurg Spine, 2019, 31(3): 317-325.
3.	Gornet MF, Lanman TH, Burkus JK, et al. Occurrence and clinical implications of heterotopic ossification after cervical disc arthroplasty with the Prestige LP Cervical Disc at 2 contiguous levels. Journal of Neurosurgery Spine, 2020. doi: 10.3171/2020.1.SPINE19816.
4.	Kang DG, Wagner SC, Lehman RA. Osteolysis in the setting of metal-on-metal cervical disc arthroplasty. Spine J, 2014, 14(7): 1362-1365.
5.	Kieser DC, Cawley DT, Fujishiro T, et al. Anterior bone loss in cervical disc arthroplasty. Asian Spine J, 2019, 13(1): 13-21.
6.	McAfee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
7.	Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
8.	Saleh KJ, Thongtrangan I, Schwarz EM. Osteolysis: medical and surgical approaches. Clin Orthop Relat Res, 2004, (427): 138-147.
9.	Kurcz B, Lyons J, Sayeed Z, et al. Osteolysis as it pertains to total hip arthroplasty. Orthop Clin North Am, 2018, 49(4): 419-435.
10.	Bosshardt DD, Chappuis V, Buser D. Osseointegration of titanium, titanium alloy and zirconia dental implants: current knowledge and open questions. Periodontol 2000, 2017, 73(1): 22-40.
11.	Heo DH, Lee DC, OH JY, et al. Bone loss of vertebral bodies at the operative segment after cervical arthroplasty: a potential complication? Neurosurgical Focus, 2017, 42(2): E7.
12.	Joaquim AF, Lee NJ, Lehan RA, et al. Osteolysis after cervical disc arthroplasty. Eur Spine J, 2020. doi: 10.1007/s00586-020-06578-2.
13.	Hacker FM, Babcock RM, Hacker RJ. Very late complications of cervical arthroplasty: results of 2 controlled randomized prospective studies from a single investigator site. Spine (Phila Pa 1976), 2013, 38(26): 2223-2226.
14.	Frost HM. A 2003 update of bone physiology and Wolff’s Law for clinicians. Angle Orthod, 2004, 74(1): 3-15.
15.	Chen TY, Chen WH, Tzeng CY, et al. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J, 2020, 20(8): 1211-1218.
16.	Ganbat D, Kim YH, Kim K, et al. Effect of mechanical loading on heterotopic ossification in cervical total disc replacement: a three-dimensional finite element analysis. Biomech Model Mechanobiol, 2016, 15(5): 1191-1199.
17.	Rong X, Gong Q, Liu H, et al. The effect of deviated center of rotation on flexion-extension range of motion after single-level cervical arthroplasty: an in vivo study. Spine (Phila Pa 1976), 2014, 39(26): B12-18.
18.	Lübbeke A, Garavaglia G, Barea C, et al. Influence of obesity on femoral osteolysis five and ten years following total hip arthroplasty. J Bone Joint Surg (Am), 2010, 92(10): 1964-1972.
19.	Huiskes R, Weinans H, van Rietbergen B. The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop Relat Res, 1992, (274): 124-134.
20.	Dunbar L, Vidakovic H, Löffler S, et al. Anterior cervical spine blood supply: a cadaveric study. Surg Radiol Anat, 2019, 41(6): 607-611.
21.	Lee JH, Kim KT, Suk KS, et al. Avascular necrosis of the spine in solid posterior fusion segments. Spine (Phila Pa 1976), 2009, 34(4): E158-161.

1. Nunley PD, Kerr EJ, Cavanaugh DA, et al. Adjacent segment pathology after treatment with cervical disc arthroplasty or anterior cervical discectomy and fusion, part 2: clinical results at 7-year follow-up. Int J Spine Surg, 2020, 14(3): 278-285.
2. Gornet MF, Burkus JK, Shaffrey ME, et al. Cervical disc arthroplasty: 10-year outcomes of the Prestige LP cervical disc at a single level. J Neurosurg Spine, 2019, 31(3): 317-325.
3. Gornet MF, Lanman TH, Burkus JK, et al. Occurrence and clinical implications of heterotopic ossification after cervical disc arthroplasty with the Prestige LP Cervical Disc at 2 contiguous levels. Journal of Neurosurgery Spine, 2020. doi: 10.3171/2020.1.SPINE19816.
4. Kang DG, Wagner SC, Lehman RA. Osteolysis in the setting of metal-on-metal cervical disc arthroplasty. Spine J, 2014, 14(7): 1362-1365.
5. Kieser DC, Cawley DT, Fujishiro T, et al. Anterior bone loss in cervical disc arthroplasty. Asian Spine J, 2019, 13(1): 13-21.
6. McAfee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
7. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
8. Saleh KJ, Thongtrangan I, Schwarz EM. Osteolysis: medical and surgical approaches. Clin Orthop Relat Res, 2004, (427): 138-147.
9. Kurcz B, Lyons J, Sayeed Z, et al. Osteolysis as it pertains to total hip arthroplasty. Orthop Clin North Am, 2018, 49(4): 419-435.
10. Bosshardt DD, Chappuis V, Buser D. Osseointegration of titanium, titanium alloy and zirconia dental implants: current knowledge and open questions. Periodontol 2000, 2017, 73(1): 22-40.
11. Heo DH, Lee DC, OH JY, et al. Bone loss of vertebral bodies at the operative segment after cervical arthroplasty: a potential complication? Neurosurgical Focus, 2017, 42(2): E7.
12. Joaquim AF, Lee NJ, Lehan RA, et al. Osteolysis after cervical disc arthroplasty. Eur Spine J, 2020. doi: 10.1007/s00586-020-06578-2.
13. Hacker FM, Babcock RM, Hacker RJ. Very late complications of cervical arthroplasty: results of 2 controlled randomized prospective studies from a single investigator site. Spine (Phila Pa 1976), 2013, 38(26): 2223-2226.
14. Frost HM. A 2003 update of bone physiology and Wolff’s Law for clinicians. Angle Orthod, 2004, 74(1): 3-15.
15. Chen TY, Chen WH, Tzeng CY, et al. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J, 2020, 20(8): 1211-1218.
16. Ganbat D, Kim YH, Kim K, et al. Effect of mechanical loading on heterotopic ossification in cervical total disc replacement: a three-dimensional finite element analysis. Biomech Model Mechanobiol, 2016, 15(5): 1191-1199.
17. Rong X, Gong Q, Liu H, et al. The effect of deviated center of rotation on flexion-extension range of motion after single-level cervical arthroplasty: an in vivo study. Spine (Phila Pa 1976), 2014, 39(26): B12-18.
18. Lübbeke A, Garavaglia G, Barea C, et al. Influence of obesity on femoral osteolysis five and ten years following total hip arthroplasty. J Bone Joint Surg (Am), 2010, 92(10): 1964-1972.
19. Huiskes R, Weinans H, van Rietbergen B. The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop Relat Res, 1992, (274): 124-134.
20. Dunbar L, Vidakovic H, Löffler S, et al. Anterior cervical spine blood supply: a cadaveric study. Surg Radiol Anat, 2019, 41(6): 607-611.
21. Lee JH, Kim KT, Suk KS, et al. Avascular necrosis of the spine in solid posterior fusion segments. Spine (Phila Pa 1976), 2009, 34(4): E158-161.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of infuence factors of anterior bone loss after cervical disc arthroplasty and its effect on effectiveness

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