Abstract：
OBJECTIVE: Cervical total disc replacement (cTDR) has been established as an alternative treatment for degenerative cervical radiculopathy and myelopathy. While the rate of complications for cTDR is reasonably low, recent studies have focused on bone loss after cTDR. The purpose of this work is to develop a clinical management plan for cTDR patients with evidence of bone loss. To guide our recommendations, we undertook a review of the literature and aimed to determine: (1) how bone loss was identified/imaged, (2) whether pre- or intraoperative assessments of infection or histology were performed, and (3) what decision-making and revision strategies were employed.
METHODS: We performed a search of the literature according to PRISMA guidelines. Included studies reported the clinical performance of cTDR and identified instances of cervical bone loss.
RESULTS: Eleven case studies and 20 cohort studies were reviewed, representing 2073 patients with 821 reported cases of bone loss. Bone loss was typically identified on radiographs during routine follow-up or by computed tomography (CT) for patients presenting with symptoms. Assessments of infection as well as histological and/or explant assessment were sporadically reported. Across all reviewed studies, multiple mechanisms of bone loss were suspected, and severity and progression varied greatly. Many patients were reportedly asymptomatic, but others experienced symptoms like progressive pain and paresthesia.
CONCLUSIONS: Our findings demonstrate a critical gap in the literature regarding the optimal management of patients with bone loss following cTDR, and treatment recommendations based on our review are impractical given the limited amount and quality evidence available. However, based on the authors\' extensive clinical experience, close follow-up of specific radiographic observations and serial radiographs to assess the progression/severity of bone loss and implant changes are recommended. CT findings can be used for clinical decision-making and further follow-up care. The pattern and rate of progression of bone loss, in concert with patient symptomatology, should determine whether non-operative or surgical intervention is indicated. Future studies involving implant retrieval, histopathological, and microbiological analysis for patients undergoing cTDR revision for bone loss are needed.
METHODS: We performed a search of the literature according to PRISMA guidelines. Included studies reported the clinical performance of cTDR and identified instances of cervical bone loss.
RESULTS: Eleven case studies and 20 cohort studies were reviewed, representing 2073 patients with 821 reported cases of bone loss. Bone loss was typically identified on radiographs during routine follow-up or by computed tomography (CT) for patients presenting with symptoms. Assessments of infection as well as histological and/or explant assessment were sporadically reported. Across all reviewed studies, multiple mechanisms of bone loss were suspected, and severity and progression varied greatly. Many patients were reportedly asymptomatic, but others experienced symptoms like progressive pain and paresthesia.
CONCLUSIONS: Our findings demonstrate a critical gap in the literature regarding the optimal management of patients with bone loss following cTDR, and treatment recommendations based on our review are impractical given the limited amount and quality evidence available. However, based on the authors\' extensive clinical experience, close follow-up of specific radiographic observations and serial radiographs to assess the progression/severity of bone loss and implant changes are recommended. CT findings can be used for clinical decision-making and further follow-up care. The pattern and rate of progression of bone loss, in concert with patient symptomatology, should determine whether non-operative or surgical intervention is indicated. Future studies involving implant retrieval, histopathological, and microbiological analysis for patients undergoing cTDR revision for bone loss are needed.
摘要：
目的：颈椎间盘置换术（cTDR）已被确定为退行性神经根病和脊髓病的替代治疗方法。虽然cTDR的并发症发生率相当低，最近的研究集中在cTDR后的骨丢失。这项工作的目的是为有骨丢失证据的cTDR患者制定临床管理计划。为了指导我们的建议，我们对文献进行了回顾，旨在确定：(1)骨丢失是如何识别/成像的，(2)术前或术中是否进行感染或组织学评估，(3)采用了哪些决策和修订策略。
方法：我们根据PRISMA指南进行了文献搜索。纳入的研究报告了cTDR的临床表现，并确定了颈椎骨丢失的情况。
结果：回顾了11个案例研究和20个队列研究，代表2073例患者和821例报告的骨丢失病例。对于出现症状的患者，通常在常规随访期间或通过计算机断层扫描（CT）在X线片上发现骨丢失。偶尔报告感染评估以及组织学和/或外植体评估。在所有审查的研究中，怀疑有多种骨丢失机制，严重程度和进展差异很大。据报道，许多患者无症状，但其他人出现了进行性疼痛和感觉异常等症状。
结论：我们的研究结果表明，在cTDR术后骨丢失患者的最佳管理方面，文献中存在重大差距。鉴于现有的证据数量和质量有限,基于我们审查的治疗建议是不切实际的.然而,根据作者丰富的临床经验，建议密切随访特定的影像学观察和系列X光片,以评估骨丢失和植入物变化的进展/严重程度.CT检查结果可用于临床决策和进一步的随访护理。骨丢失的模式和进展速度，与患者症状学一致，应确定是否需要非手术或手术干预。涉及植入物取回的未来研究，组织病理学,需要对接受cTDR翻修术治疗骨丢失的患者进行微生物学分析。
方法：我们根据PRISMA指南进行了文献搜索。纳入的研究报告了cTDR的临床表现，并确定了颈椎骨丢失的情况。
结果：回顾了11个案例研究和20个队列研究，代表2073例患者和821例报告的骨丢失病例。对于出现症状的患者，通常在常规随访期间或通过计算机断层扫描（CT）在X线片上发现骨丢失。偶尔报告感染评估以及组织学和/或外植体评估。在所有审查的研究中，怀疑有多种骨丢失机制，严重程度和进展差异很大。据报道，许多患者无症状，但其他人出现了进行性疼痛和感觉异常等症状。
结论：我们的研究结果表明，在cTDR术后骨丢失患者的最佳管理方面，文献中存在重大差距。鉴于现有的证据数量和质量有限,基于我们审查的治疗建议是不切实际的.然而,根据作者丰富的临床经验，建议密切随访特定的影像学观察和系列X光片,以评估骨丢失和植入物变化的进展/严重程度.CT检查结果可用于临床决策和进一步的随访护理。骨丢失的模式和进展速度，与患者症状学一致，应确定是否需要非手术或手术干预。涉及植入物取回的未来研究，组织病理学,需要对接受cTDR翻修术治疗骨丢失的患者进行微生物学分析。
