Zeitschrift für Wirbelsäulen- und Neurochirurgie

Anterior Bone Loss in an Anterior Cervical Disectomy and Fusion

Kieser DC, Mazas S, Roscop C, Cawley D, Boissiere L, Obeid I, Pointillart V, Vital JM and Gille O

Background: Anterior bone loss (ABL) has recently been described in cervical disc arthroplasty (CDA). Its cause remains unknown but because it has not been described in anterior cervical disectomy and fusion (ACDF) researchers believe the cause relates to wear debris. Therefore, this study aims to describe ABL in ACDF and therefore support alternative causes for this phenomenon. Methods: Two case reports of ABL after ACDF are presented. Results: Both cases developed early ABL (within 3 months) that was static by one year. Neither patient developed neck pain (VAS 0/10). The functional outcomes of the first case were excellent and no further treatment was required. The second patient developed adjacent segment disease and worsened myelopathy necessitating further surgery. Conclusion: ABL occurs in ACDF, supporting the hypothesis that ABL is a surgical technique rather than implant specific phenomenon. Clinical relevance: ABL is not specific to CDA and therefore not likely to be caused by wear debris, but rather surgical technique or stress shielding.