Anterior Bone Loss in Cervical Disc Arthroplasty.
Anterior Bone Loss in Cervical Disc Arthroplasty.
复制标题
DOI：
10.31616/asj.2018.0008
复制
发表时间：
2019-03
影响因子：
2.3
通讯作者：
Gille O
中科院分区：
文献类型：
--
作者：
Kieser DC;Cawley DT;Fujishiro T;Tavolaro C;Mazas S;Boissiere L;Obeid I;Pointillart V;Vital JM;Gille O
回顾性、纵向观察性研究。描述颈椎间盘置换术（CDA）中前路骨丢失（ABL）的自然史，并介绍一种评估分类系统。ABL最近被认为是CDA的并发症，但其原因和临床影响仍不清楚。对非龙骨状CDA患者（146例）进行了回顾性分析。在6周、3、6、9、12、18和24个月时进行X线检查，此后每年进行一次，至少持续5年。将这些与术后最初的X线片进行比较，以确定ABL。在3个月和5年时记录视觉模拟量表疼痛评分。术后5年记录颈部功能障碍指数。确定了自然历史，并引入了分类系统。对114例患者进行了完整的影像学评估，其中156例进行了颈椎间盘置换（CDR），309例使用了终板（平均年龄：45.3岁;最小年龄：28岁;最大年龄：65岁; 57%为女性）。ABL发生在57.1%的CDR中（45.5%轻度，8.3%中度和3.2%重度），在手术后3个月内开始，并遵循良性病程，在初始骨吸收后骨量改善。ABL程度与疼痛或功能结局之间无相关性，无植入物翻修。ABL常见（57.1%）。它发生在早期阶段（3个月内），通常在第一年后具有稳定的放射学特征的非进展性自然史。大多数ABL病例是轻度的，但重度ABL发生在约3%的CDA中。ABL不影响患者的临床结局或翻修手术的要求。因此，外科医生在治疗接受CDA的患者时应考虑ABL。
Retrospective, longitudinal observational study. To describe the natural history of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and introduce a classification system for its assessment. ABL has recently been recognized as a complication of CDA, but its cause and clinical effects remain unknown. 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. 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. 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.