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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Research article

Proposal for a classification system of radiographic bone changes after cervical disc replacement

Authors: Armen Khachatryan, Frank M. Phillips, Todd H. Lanman, Gunnar B. Andersson, Joshua J. Jacobs, Steven M. Kurtz

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

The goal of this study is to propose a classification system with a common nomenclature for radiographic observations of periprosthetic bone changes following cTDR.

Methods

Aided by serial plain radiographs from recent cTDR cases (34 patients; 44 devices), a panel of experts assembled for the purpose of creating a classification system to aid in reproducibly and accurately identifying bony changes and assessing cTDR radiographic appearance. Subdividing the superior and inferior vertebral bodies into 3 equal sections, observed bone loss such as endplate rounding, cystic erosion adjacent to the endplate, and cystic erosion not adjacent to the endplate, is recorded. Determining if bone loss is progressive, based on serial radiographs, and estimating severity of bone loss (measured by the percentage of end plate involved) is recorded. Additional relevant bony changes and device observations include radiolucent lines, heterotopic ossification, vertebral body olisthesis, loss of core implant height, and presence of device migration, and subsidence.

Results

Serial radiographs from 19 patients (25 devices) implanted with a variety of cTDR designs were assessed by 6 investigators including clinicians and scientists experienced in cTDR or appendicular skeleton joint replacement. The overall agreement of assessments ranged from 49.9% (95% bootstrap confidence interval 45.1–73.1%) to 94.7% (95% CI 86.9–100.0%). There was reasonable agreement on the presence or absence of bone loss or radiolucencies (range: 58.4% (95% CI 51.5–82.7%) to 94.7% (95% CI 86.9–100.0%), as well as in the progression of radiolucent lines (82.9% (95% CI 74.4–96.5%)).

Conclusions

The novel classification system proposed demonstrated good concordance among experienced investigators in this field and represents a useful advancement for improving reporting in cTDR studies.

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Title: Proposal for a classification system of radiographic bone changes after cervical disc replacement
Authors: Armen Khachatryan
Frank M. Phillips
Todd H. Lanman
Gunnar B. Andersson
Joshua J. Jacobs
Steven M. Kurtz
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04679-y

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Springer Medicine

Proposal for a classification system of radiographic bone changes after cervical disc replacement

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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