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Anterior bone loss: A common phenomenon which should be considered as bone remodeling process existed not only in patients underwent cervical disk replacement but also those with anterior cervical diskectomy and fusion

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Abstract

Objective

Anterior bone loss (ABL) was considered as a non-progressive process secondary only to motion-preserving implant and has been noticed recently in cervical disk replacement (CDR) let alone patients with anterior cervical diskectomy and fusion (ACDF). Our purpose is to reveal this unnoticed phenomenon in ACDF and further explore its clinical and radiological outcomes.

Methods

A total of 77 patients underwent ACDF with a minimum follow-up of at least one year were retrospectively reviewed. The average follow-up time was 22.51 ± 16.31 months. There were 50 patients in group A with ABL, while there were 27 patients in group B without ABL. ABL was measured and classified into four grades according to Kieser’s methods. Clinical evaluation, radiological parameters and fusion rate were recorded.

Results

The incidence of bone ABL was 64.9% of Zero-P and 55.2% of endplates. The incidence of upper and lower endplates was 61% and 49%, respectively, and such difference was not significant. Mild ABL occurred in 22%, moderate ABL in 38% and severe ABL of 40% patients underwent ACDF with ABL. ABL would not affect both clinical outcomes and fusion rate. However, ABL would result in a higher incidence of subsidence.

Conclusion

ABL should be considered as a common phenomenon that both CDR and ACDF owned a non-progressive process which confined in one year. ABL would result in a higher incidence of subsidence. Luckily, this phenomenon does not have an effect on postoperative clinical and fusion rate.

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Data availability

Datasets are available from the corresponding author on reasonable request.

Abbreviations

CDR:

Cervical disk replacement

ACDF:

Anterior cervical diskectomy and fusion

JOA:

Japanese orthopedic association

NDI:

Neck disability index

VAS:

Visual analog scale

Cobb C:

Overall Cobb angle

Cobb S:

Segmental Cobb angle

LE:

Length of endplate

CDDD:

Cervical degenerative disk disease

ASD:

Adjacent segment degeneration

HO:

Heterotopic ossification

CT:

Computed tomography

MRI:

Magnetic resonance imaging

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Acknowledgements

We thank the nursing staffs from our department and the patients enrolled in this study for their supports.

Funding

This study was supported by the 135 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZYJC18029), Sichuan Province Science and Technology Support Program of China (NO. 2020YFS0077), Post-Doctor Research Project, West China Hospital, Sichuan University (NO. 2019HXBH063), Postdoctoral Science Foundation of China (NO. 2020M673240) and the West China Nursing Discipline Development Special Fund Project. (NO. HXHL19016 to Ying Hong). No relevant financial activities outside of the submitted work.

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Author notes

  1. Yifei Deng and Beiyu Wang contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Yifei Deng, Beiyu Wang, Yi Yang, Rong Xing, Xiaofei Wang & Hao Liu

  2. Department of Operation Room, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Ying Hong

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  1. Yifei Deng
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Correspondence to Ying Hong or Hao Liu.

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This study approved by the Institutional Review Board of West China Hospital. Informed consent was obtained from all individual participants included in this study.

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Deng, Y., Wang, B., Hong, Y. et al. Anterior bone loss: A common phenomenon which should be considered as bone remodeling process existed not only in patients underwent cervical disk replacement but also those with anterior cervical diskectomy and fusion. Eur Spine J 32, 977–985 (2023). https://doi.org/10.1007/s00586-022-07504-4

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  • DOI: https://doi.org/10.1007/s00586-022-07504-4

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