• Andrei Fernandes Joaquim, Nathan J Lee, Ronald A Lehman, Luis M Tumialán, and K Daniel Riew.
• Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, SP, Brazil. andjoaquim@yahoo.com.
• Eur Spine J. 2020 Nov 1; 29 (11): 2723-2733.

PurposeCervical disc arthroplasty (CDA) has become an increasingly popular treatment for cervical degenerative disc disease. One potential complication is osteolysis. However, current literature on this topic appears limited. The purpose of this study is to elucidate the incidence, aetiology, consequence, and subsequent treatment of this complication.MethodsA systematic literature review was performed according to the PRISMA guidelines. Studies discussing the causes, incidence and management of osteolysis after a CA were included.ResultsA total of nine studies were included. We divided these studies into two groups: (1) large case series in which an active radiological evaluation for osteolysis was performed (total = six studies), (2) case report studies, which discussed symptomatic cases of osteolysis (total = three). The incidence of asymptomatic osteolysis ranged from 8 to 64%; however, only one study reported an incidence of < 10% and when this case was excluded the incidence ranged from 44 to 64%. Severe asymptomatic bone loss (exposure of the implant) was found in less than 4% of patients. Bone loss from osteolysis appeared to occur early (< 1 year) after surgery and late (> 1 year) as well. Symptomatic patients with osteolysis often required revision surgery. These patients required removal of implant and conversion to fusion in the majority of the cases.ConclusionsOsteolysis after CDA is common; however, the majority of cases have only mild or asymptomatic presentations that do not require revision surgery. The timing of osteolysis varies significantly. This may be due to differences in the aetiology of osteolysis.

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