Purpose Cervical Total Disc Replacement (CTDR) related periprosthetic osteolysis is inconsistently reported. The purpose of this study is to assess the previously published TDR Osteolysis Grading Scale, a quantitative classification system of CTDR-related osteolysis, and to assess its reliability and utility using Computer Tomography (CT) and X-ray imaging. Methods Participants were assigned to Groups A (CT, 20 participants, 27 implants) and B (X-ray, 20 participants, 26 implants). Four blinded raters independently measured osteolytic cysts and both vertebral endplates, calculated the percentage of osteolysis and assigned osteolysis grades: Grade 0, no osteolysis; Grade 1, < 50% of 1 endplate; Grade 2, < 50% of both endplates; Grade 3, ≥ 50% of 1 endplate; Grade 4, ≥ 50% of both endplates. Inter-rater reliability and sensitivity were assessed using intraclass correlation coefficients (ICC), Fleiss’ and Cohen’s Kappa statistics and sensitivity testing. Results Group A had good reliability for osteolytic cyst measurements (ICC = 0.78–0.79), poor reliability for endplate measurements (ICC = 0.41–0.45) and moderate reliability for osteolysis grades (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\kappa\)</EquationSource> </InlineEquation>-coefficient = 0.42). Group B had moderate reliability for osteolytic cyst (ICC = 0.55–0.57) and endplate measurements (ICC = 0.55–0.64) and fair reliability for osteolysis grades (<InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\kappa\)</EquationSource> </InlineEquation>-coefficient = 0.30). Reliability between reference grades and assigned grades was moderate for Group A (<InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(\kappa\)</EquationSource> </InlineEquation>-coefficient = 0.46–0.60) and fair for Group B (<InlineEquation ID="IEq4"> <EquationSource Format="TEX">\(\kappa\)</EquationSource> </InlineEquation>-coefficient = 0.08–0.35). Sensitivity was greater for high grade osteolysis (grade 3 and 4) in Group A (0.80–1) than Group B (0.17–0.50). Conclusion The TDR Osteolysis Grading Scale demonstrated good reliability and sensitivity amongst raters with CT. Implementing this tool may aid in standardising osteolysis reporting, monitoring osteolysis progression and clinical decision-making.

The Total Disc Replacement Osteolysis Grading Scale – a simple, reliable and quantifiable tool for assessing, managing and reporting osteolysis after cervical total disc replacement

期刊论文
出版模式：

开放获取
发表日期：

2025年7月31日

查看全文

Alana Celenza,
Jessica Gaff,
Moreica Pabbruwe,
Juan Amaya,
Ashik Amlani,
Andrew Berg,
Sonja Häckel,
Michael Kern,
Andrew Miles,
Paul Taylor,
Gregory Cunningham

摘要

Purpose

Cervical Total Disc Replacement (CTDR) related periprosthetic osteolysis is inconsistently reported. The purpose of this study is to assess the previously published TDR Osteolysis Grading Scale, a quantitative classification system of CTDR-related osteolysis, and to assess its reliability and utility using Computer Tomography (CT) and X-ray imaging.

Methods

Participants were assigned to Groups A (CT, 20 participants, 27 implants) and B (X-ray, 20 participants, 26 implants). Four blinded raters independently measured osteolytic cysts and both vertebral endplates, calculated the percentage of osteolysis and assigned osteolysis grades: Grade 0, no osteolysis; Grade 1, < 50% of 1 endplate; Grade 2, < 50% of both endplates; Grade 3, ≥ 50% of 1 endplate; Grade 4, ≥ 50% of both endplates. Inter-rater reliability and sensitivity were assessed using intraclass correlation coefficients (ICC), Fleiss’ and Cohen’s Kappa statistics and sensitivity testing.

Results

Group A had good reliability for osteolytic cyst measurements (ICC = 0.78–0.79), poor reliability for endplate measurements (ICC = 0.41–0.45) and moderate reliability for osteolysis grades ( \(\kappa\) -coefficient = 0.42). Group B had moderate reliability for osteolytic cyst (ICC = 0.55–0.57) and endplate measurements (ICC = 0.55–0.64) and fair reliability for osteolysis grades ( \(\kappa\) -coefficient = 0.30). Reliability between reference grades and assigned grades was moderate for Group A ( \(\kappa\) -coefficient = 0.46–0.60) and fair for Group B ( \(\kappa\) -coefficient = 0.08–0.35). Sensitivity was greater for high grade osteolysis (grade 3 and 4) in Group A (0.80–1) than Group B (0.17–0.50).

Conclusion

The TDR Osteolysis Grading Scale demonstrated good reliability and sensitivity amongst raters with CT. Implementing this tool may aid in standardising osteolysis reporting, monitoring osteolysis progression and clinical decision-making.