Risk factors of bone loss after Prestige-LP cervical disc arthroplasty

• Published in: European spine journal 2024-10, Vol.33 (10), p.3969-3977
• Main Authors: Wu, Tingkui, Wang, Hong, Huang, Kangkang, He, Junbo, Yan, Chunyi, Ding, Chen, Wang, Beiyu, Liu, Hao
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroplasty; Arthroplasty - adverse effects; Arthroplasty - methods; Bone loss; Bone remodeling; Bone Resorption - diagnostic imaging; Bone Resorption - etiology; Bone surgery; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Female; Humans; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Degeneration - surgery; Joint surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Statistical analysis; Surgical Orthopedics; Surgical outcomes; Total Disc Replacement - adverse effects; Total Disc Replacement - methods; Treatment Outcome
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-024-08400-9

Purpose Cervical disc arthroplasty (CDA) is widely employed for patients diagnosed with cervical degenerative disc disease (CDDD). Postoperative bone loss (BL) represents a radiological alteration that is a relatively novel consideration in the realm of CDA. This study endeavors to examine the risk factors associated with BL following CDA, aiming to elucidate the underlying mechanisms and the impact of BL on surgical outcomes. Methods A retrospective study was undertaken, encompassing consecutive patients subjected to one-level CDA, two-level CDA, or two-level hybrid surgery (HS) for the treatment of CDDD at our institution. Patient demographic and perioperative data were systematically recorded. Radiological images obtained preoperatively, at 1-week post-operation, and during the last follow-up were collected and evaluated, following with statistical analyses. Results A total of 295 patients and 351 arthroplasty segments were involved in this study. Univariate logistic regressions indicated that age ≥ 45 years and two-level HS was associated with lower risk of BL; and a greater ΔDA (change of disc angle before and after surgery) was correlated with an increased risk of BL. Multivariate logistic regression determined that two-level HS and greater ΔDA were independent preventative and risk factors for BL, respectively. Further analysis revealed that severe BL significantly elevated the risk of implant subsidence compared to non-BL and mild BL. Conclusions This study posited bone remodeling and micromotion as potential underlying mechanisms of BL. Subsequent research endeavors should delve into the divergent mechanisms and progression observed between lower- and higher-grade BL, aiming to prevent potential adverse outcomes associated with severe BL.