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Anterior Bone Loss in Cervical Disc Arthroplasty
David Christopher Kieser,Derek Thomas Cawley,Takashi Fujishiro,Celeste Tavolaro,Simon Mazas,Louis Boissiere,Ibrahim Obeid,Vincent Pointillart,Jean Marc Vital,Olivier Gille 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1
Study Design: Retrospective, longitudinal observational study. Purpose: To describe the natural history of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and introduce a classification system for its assessment. Overview of Literature: ABL has recently been recognized as a complication of CDA, but its cause and clinical effects remain unknown. Methods: 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. Results: 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. Conclusions: 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.
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David Christopher Kieser,Louis Boissiere,Anouar Bourghli,Kazunori Hayashi,Derek Cawley,Caglar Yilgor,Ahmet Alanay,Emre Acaroglu,Frank Kleinstueck,Javier Pizones,Ferran Pellise,Francisco Javier Sanchez 대한척추신경외과학회 2021 Neurospine Vol.18 No.3
Objective: To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine. Methods: Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥20°, pelvic tilt ≥25°, sagittal vertical axis ≥5 cm, thoracic kyphosis ≥60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM). Results: Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages. Conclusion: CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD.
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