Journal Article

Clinical management of bone loss in cervical total disc arthroplasty: literature review and treatment recommendations

Khachatryan, Armen, Phillips, Frank M., Bae, Hyun, Kurtz, Steven M., Jacobs, Joshua J., Lanman, Todd H., Spece, Hannah, Garrigues, Grant E., Andersson, Gunnar B. J.

2024

Overview

Purpose Cervical total disc replacement (cTDR) has been established as an alternative treatment for degenerative cervical radiculopathy and myelopathy. While the rate of complications for cTDR is reasonably low, recent studies have focused on bone loss after cTDR. The purpose of this work is to develop a clinical management plan for cTDR patients with evidence of bone loss. To guide our recommendations, we undertook a review of the literature and aimed to determine: (1) how bone loss was identified/imaged, (2) whether pre- or intraoperative assessments of infection or histology were performed, and (3) what decision-making and revision strategies were employed. Methods We performed a search of the literature according to PRISMA guidelines. Included studies reported the clinical performance of cTDR and identified instances of cervical bone loss. Results Eleven case studies and 20 cohort studies were reviewed, representing 2073 patients with 821 reported cases of bone loss. Bone loss was typically identified on radiographs during routine follow-up or by computed tomography (CT) for patients presenting with symptoms. Assessments of infection as well as histological and/or explant assessment were sporadically reported. Across all reviewed studies, multiple mechanisms of bone loss were suspected, and severity and progression varied greatly. Many patients were reportedly asymptomatic, but others experienced symptoms like progressive pain and paresthesia. Conclusion Our findings demonstrate a critical gap in the literature regarding the optimal management of patients with bone loss following cTDR, and treatment recommendations based on our review are impractical given the limited amount and quality evidence available. However, based on the authors’ extensive clinical experience, close follow-up of specific radiographic observations and serial radiographs to assess the progression/severity of bone loss and implant changes are recommended. CT findings can be used for clinical decision-making and further follow-up care. The pattern and rate of progression of bone loss, in concert with patient symptomatology, should determine whether non-operative or surgical intervention is indicated. Future studies involving implant retrieval, histopathological, and microbiological analysis for patients undergoing cTDR revision for bone loss are needed.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Bone loss / Bone Resorption - diagnostic imaging / Bone Resorption - etiology / Central nervous system diseases / Cervical Vertebrae - diagnostic imaging / Cervical Vertebrae - surgery / Clinical decision making / Computed tomography / Decision making / Humans / Literature reviews / Medicine / Medicine & Public Health / Neurosurgery / Paresthesia / Patients / Postoperative Complications - etiology / Radiography / Review Article / Spinal cord / Surgical Orthopedics / Total Disc Replacement - adverse effects / Total Disc Replacement - methods