Vertebral Body Osteolysis 6 Years After Cervical Disk Arthroplasty

Abstract

Cervical arthroplasty is an accepted and widely performed surgical intervention with usually favorable outcomes. We report a rare case of a 37-year-old woman who presented with vertebral body osteolysis, 6 years after two-level cervical arthroplasty (C5–C6 and C6–C7). The patient showed no initial complications, but at year 6 she presented with neck and radicular arm pain. Diagnostic imaging revealed osteolysis of the vertebral body C6. The patient subsequently underwent removal of the two prostheses and C6 corpectomy, followed by bridging C5 to C7 and anterior fixation. During surgery, the mantle of the prostheses appeared broken, with the core expulsed anteriorly and embedded in granulomatous scar tissue. Pathologic evaluation of the samples showed partially proliferating fibroblasts, giant cell reaction, and textile particles. Postoperatively, clinical symptoms resolved with no residual deficits. Additional research should be performed to assess the long-term complications of this procedure that should be included in the patient informed consent materials.

The lexicon for periprosthetic bone loss versus osteolysis after cervical disc arthroplasty: a systematic review

“…However, in several studies in the present review, the early onset of bone resorption led authors to conclude that wear debris was an unlikely primary cause [39,41,44,45,53]. In late onset cases, progressive osteolysis was attributed to mechanical failure of the M6-C in five studies, despite findings consistent with device failure and histopathology confirming the presence of particulate polymeric debris and giant cells [29,30,33,35,36]. This device was noted to include a sheath intended to contain and decrease debris migration, and rupture of the sheath contributed to particle-induced osteolysis [35,36].…”

“…In late onset cases, progressive osteolysis was attributed to mechanical failure of the M6-C in five studies, despite findings consistent with device failure and histopathology confirming the presence of particulate polymeric debris and giant cells [29,30,33,35,36]. This device was noted to include a sheath intended to contain and decrease debris migration, and rupture of the sheath contributed to particle-induced osteolysis [35,36]. These findings were consistent with those reported for another annulus-nucleus analog device with a sheath, the Bryan [54].…”

“…Two articles reported positive cultures for Propionibacterium acnes [29,30] and two for Staphylococcus epidermidis. [35,36] Some of the observations included abundant giant cells, granulomatous formation, macrophages, metal particles, and flakes of polymeric debris, which are features of a potentially osteolysis-inducing foreign body response [23].…”

“…Neck pain was most frequently reported for patients with osteolysis [26,27,30,[33][34][35][36][37][38]. Radicular symptoms were reported in four studies [28,33,35,38] and paresthesia was reported in three case reports [29,30,33].…”

“…Neck pain was most frequently reported for patients with osteolysis [26,27,30,[33][34][35][36][37][38]. Radicular symptoms were reported in four studies [28,33,35,38] and paresthesia was reported in three case reports [29,30,33]. Other symptoms accompanying osteolysis were: dysphagia, respiratory compromise, myelopathy, shoulder pain, distal upper extremity numbness, and decreased fine motor dexterity.…”