Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5284-5295
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5284
Anterior bone loss after cervical disc replacement: A systematic review
Xiao-Fei Wang, Yang Meng, Hao Liu, Ying Hong, Bei-Yu Wang
Xiao-Fei Wang, Yang Meng, Hao Liu, Bei-Yu Wang, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ying Hong, Department of Anesthesia and Operation Center/West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu H designed the research; Wang XF and Meng Y performed the research; Wang XF and Meng Y analyzed the data; Wang XF wrote the paper; Liu H, Wang BY and Hong Y supervised the paper; all authors read and approved the final manuscript.
Supported by West China Nursing Discipline Development Special Fund Project, Sichuan University, No. HXHL19016; and 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University, No. ZYJC18029.
Conflict-of-interest statement: The authors declare they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hao Liu, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu 610041, Sichuan Province, China. dr.liuhao6304@yahoo.com
Received: May 6, 2020
Peer-review started: May 6, 2020
First decision: August 23, 2020
Revised: September 5, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: November 6, 2020
Processing time: 184 Days and 1.6 Hours
Abstract
BACKGROUND

Anterior bone loss (ABL) is a relatively easily neglected condition after cervical disc replacement (CDR). Whether this phenomenon is a radiological anomaly or a complication remains controversial. Several studies have reported the clinical characteristics of ABL and speculated on the pathogenic mechanism based on a certain type of artificial disc, while the overall understanding of ABL is lacking.

AIM

To describe the prevalence, impacts, and risk factors of ABL after CDR.

METHODS

We searched the PubMed, Cochrane Library, and Excerpta Medica databases using the terms “bone loss” or “bone remodeling” or “bone absorption” or “osteolysis” or “implant loosening” or “implant migration” or “hypersensitivity” or “hyperreactivity”, “cervical disc replacement” or “cervical disc arthroplasty” or “total disc replacement”. Eligible manuscripts on the prevalence and impacts of ABL were reviewed by the authors. Data extraction was performed using an established extraction form. The results of the included studies were described narratively.

RESULTS

Six studies met the inclusion and exclusion criteria. One was a prospective study and the others were retrospective studies. A total of 440 patients with 536 segments were included. The artificial cervical discs included Bryan, Baguera-C, Discocerv, and Mobi-C. The prevalence of ABL ranged from 3.13% to 91.89%, with a combined overall prevalence of 41.84%. ABL occurred within 6 mo and stopped 12 mo after surgery. Several cases were noted to have a self-healing process. Severe ABL resulted in segmental kyphosis, implant subsidence, and persistent neck pain. ABL may be related to heterotopic ossification. Multilevel surgery may be one of the risk factors for ABL.

CONCLUSION

ABL is a common condition after CDR. The underlying mechanisms of ABL may include stress concentration and injury to nutrient vessels. ABL should be considered a complication after CDR as it was associated with neck pain, implant subsidence, and heterotopic ossification.

Keywords: Bone loss; Bone remodeling; Stress shielding; Risk factor; Systematic review

Core Tip: Anterior bone loss (ABL) is a common condition after cervical disc replacement. Several studies have reported the clinical characteristics of ABL; however, it remains unclear whether this phenomenon is a radiological anomaly or a complication. In this review, we found that the prevalence of ABL after cervical disc replacement was related to the type of implant. ABL should be considered a complication after cervical disc replacement as it was associated with neck pain, implant subsidence, and heterotopic ossification. Fortunately, ABL did not progress after 12 mo postoperatively, and some cases showed a self-healing phenomenon. The underlying mechanisms of ABL may include stress concentration and injury to nutrient vessels.