Progressive Vertebral Body Osteolysis After Cervical Disc Arthroplasty
Progressive Vertebral Body Osteolysis After Cervical Disc Arthroplasty
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DOI：
10.1097/brs.0b013e3181fd863b
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发表时间：
2011-06-15
期刊：
影响因子：
3
通讯作者：
Gluf, Wayne M.
中科院分区：
文献类型：
--
作者：
Tumialan, Luis. M.;Gluf, Wayne M.
研究设计。案例报告.客观的。回顾1例因顽固性神经根性疾病行颈椎关节置换术后椎体进行性骨溶解患者的治疗。自2007年美国食品和药物管理局(FDA)批准颈椎关节置换设备以来，许多外科医生已将这项技术应用于临床实践。随着关节成形术变得越来越普遍，这种技术特有的并发症不可避免。到目前为止，只有有限数量的并发症在文献中报道，表明该装置是安全的。据作者所知，这份报告是龙骨人工关节置换术发生骨溶解的第一例并发症。一位30岁的男性接受了C5-C6全关节置换术，初步效果良好。在9个月和15个月时，逐渐恶化的颈部疼痛促使重复成像，显示在高级合金终板的龙骨附近有进行性骨溶解过程。这就需要探查手术部位，植入植入物，并将关节盘置换术转变为关节融合术。对溶骨区的检查未发现任何大体异常。制造商对该设备进行了测试，没有发现任何缺陷。全面的感染性检查结果为阴性。该装置植入后，溶骨过程停止。骨关节融合术在6个月后完成，患者在初次手术后29个月和术后14个月仍无症状。这份报告展示了一例使用龙骨人工关节置换术的进行性骨溶解的特殊病例。免疫介导的骨溶解过程似乎是临床症状和放射学进展的合理解释。考虑到ProDisc-C自2007年FDA批准以来的多年使用，这种设备的并发症很少见。这是第一例报告的这种植入物的骨溶解病例。
Study Design. Case report.Objective. To review the management of a patient with progressive osteolysis of the vertebral body after undergoing cervical arthroplasty for management of a refractory radiculopathy.Summary of Background Data. Since the Food and Drug Administration's (FDA) approval of cervical arthroplasty devices in 2007, many surgeons have incorporated this technology into clinical practice. As arthroplasty becomes more widespread, complications unique to this technology are inevitable. To date, only a limited number of complications have been reported in the literature suggesting the safety of this device. To the authors' knowledge, this report represents the first complication of osteolysis from a keel based arthroplasty device.Methods. A 30-year-old man underwent an uneventful C5-C6 total disc arthroplasty with initial benefit. Progressively worsening neck pain prompted repeat imaging at 9 and 15 months, which showed a progressive osteolytic process in the vicinity of the keel of the superior alloy endplate. This necessitated exploration of the surgical site, explantation of the implant and conversion of the disc arthroplasty to an arthrodesis.Results. Examination of the osteolytic area did not reveal any gross abnormalities. Testing of the device by the manufacturer did not reveal any defects. A comprehensive infectious workup was negative. The osteolytic process halted after the explantation of the device. A bony arthrodesis was achieved at 6 months and the patient remains symptom free 29 months after the initial procedure and 14 months after the revision.Conclusion. This report illustrates an exceptional case of a progressive osteolysis with a keel based arthroplasty device. An immune mediated osteolytic process appears to be a plausible explanation for the clinical symptoms and radiographic progression seen in this case. Given the years of use of the ProDisc-C since its FDA approval in 2007, complications with this device are rare. This represents the first reported case of osteolysis from such an implant.