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Patel N, Abdelmalek G, Coban D, Changoor S, Sinha K, Hwang K, Emami A. Should patient eligibility criteria for cervical disc arthroplasty (CDA) be expanded? A retrospective cohort analysis of relatively contraindicated patients undergoing CDA. Spine J 2024; 24:210-218. [PMID: 37774985 DOI: 10.1016/j.spinee.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is a safe and effective alternative to anterior cervical discectomy and fusion (ACDF) in the treatment of various degenerative pathologies with advantages of motion preservation and lower rates of adjacent segment degeneration (ASD). Absolute contraindications for CDA have been well outlined in order to prevent adverse outcomes in patients. However, in cases of patients with relative contraindications (kyphotic deformity, prior cervical surgery, etc.), there remains controversy. There is minimal literature evaluating long-term outcomes in this patient population. PURPOSE To compare long-term clinical and functional outcomes of CDA in typical patients versus those with relative contraindications. DESIGN Retrospective cohort review. PATIENT SAMPLE Eighty-nine patients were included in the study: 55 (no contraindications) in Group 1 and 34 (relatively contraindicated) in Group 2 and 26 (preoperative segmental kyphosis) in Group 3. OUTCOME MEASURES (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS), and neck disability index (NDI) scores. METHODS Patients were placed in the relatively contraindicated cohort if they possessed at least one of the following: (1) segmental kyphosis of 5° to 10°, (2) significant loss of disc height (between 50% and 75% of initial measurements or 1.5-3mm), (3) bridging osteophytes, and (4) prior cervical spine surgery based on preoperative cervical radiographs. The other cohort included patients without any relative contraindication who underwent CDA over the same time frame. Additionally, a subgroup analysis was used to compare those without any contraindications to those with only preoperative segmental kyphosis. Patients were included in this study if they met the following criteria: over 18 years of age, minimum follow-up of 24 months, and availability of complete medical records. Patient demographics, levels operated on, and perioperative outcomes were assessed between the two groups. Revision and complication rates were recorded. Functional outcomes scores were compared using VAS and NDI scores at 6-months, 12-months and final follow-up. RESULTS Mean follow-up was 40.8 months in Group 1 and 38.3 months in Group 2 (p=.569). Complication rates were 21.8% in Group 1 and 26.4% in Group 2 (p=.615). Complication rates in a comparison between Groups 1 and 3 were statistically insignificant (p=.383). The most common complication was transient approach-related postoperative dysphagia (Group 1: 20% vs Group 2: 23.5%, p=.693). No significant differences were observed in the rates of transient dysphonia (Group 1: 0.0% vs Group 2: 2.9%, p=.201), adjacent segment degeneration (ASD) (Group 1: 1.8% vs Group 2: 0.0%, p=.429), infection (Group 1: 1.8% vs Group 2: 2.9%, p=.712), heterotopic ossification (Group 1: 49.1% vs Group 2: 50.0%, p=.934) or spontaneous fusion (Group 1: 1.8% vs Group 2: 2.9%, p=.728). No revision surgeries were observed in either cohort. All three groups demonstrated significant improvements in their VAS and NDI scores compared with preoperative measurements (p<.001), but no significant differences were found in the degree of improvement between groups at any point in time. CONCLUSIONS Our study found no significant differences in clinical and functional outcomes between patients undergoing 1- and 2-level CDA with relative contraindications versus typical patients. These findings suggest that patient eligibility criteria for CDA may warrant expansion. However, future prospective studies over a longer period of follow-up are necessary to corroborate our results.
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Affiliation(s)
- Neil Patel
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - George Abdelmalek
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Daniel Coban
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Stuart Changoor
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Kumar Sinha
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Ki Hwang
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA
| | - Arash Emami
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07470, USA.
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Ko CC, Feng BK, Kuo YH, Kuo CH, Tu TH, Chang CC, Cheng H, Huang WC, Wu JC. Incidence and Risk Factor of Implant Dislocation After Cervical Disk Arthroplasty: A Retrospective Cohort Analysis of 756 Patients. Neurosurgery 2023; 93:330-338. [PMID: 36805569 DOI: 10.1227/neu.0000000000002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Implant dislocation after cervical disk arthroplasty (CDA) is obviously a critical complication, but no information about the incidence and associated risk factor has been reported. OBJECTIVE To investigate the incidence and risk factor of implant dislocation after CDA by a retrospective cohort analysis. METHODS A retrospective review of a consecutive series of CDA performed between January 2009 and March 2021 at a single institution was conducted. Analyses of chart records and radiological data established the incidence and associated risk factor of implant dislocation after CDA. A Kaplan-Meier survival estimation of implant survival was performed. RESULTS A total of 756 consecutive patients were included in this analysis. Five patients (0.7%) had a migration and even dropout of the artificial disk. The overall cumulative survival rate of the implant reached approximately 99.3% of the 756 patients. Preoperative kyphosis was significantly related to implant dislocation ( P = .016), with an odds ratio of 15.013. CONCLUSION The incidence of implant dislocation after CDA is as low as 0.7% or 5/756 patients. Preoperative kyphosis significantly increases the risk of postoperative implant dislocation by a factor of 15. The migrating implants could be revealed on radiographs as early as 0.9 to 1.4 months postoperatively and were revised to anterior cervical diskectomy and fusion within half a year. No new event of implant dislocation occurred half a year postoperatively. The overall cumulative survival rate of the implant reached 99.3% of the 756 patients. In conclusion, CDA remains a safe and reliable procedure.
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Affiliation(s)
- Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bo-Kai Feng
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Chen S, Deng Y, Liu H, Wu T, Huang K, He J, Wang B. Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience. J Orthop Surg Res 2023; 18:345. [PMID: 37165448 PMCID: PMC10170693 DOI: 10.1186/s13018-023-03819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/02/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION According to the different numbers and relative locations of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF), three-level hybrid surgery (HS) has many constructs. The purpose of this retrospective study was to compare the sagittal alignment parameters of HS and ACDF for cervical degenerative disc disease (CDDD) and the association of the respective parameters. METHODS This study involved patients with three-level CDDD who underwent ACDF or HS at our institution between June 2012 and August 2021. This follow-up included one-level CDR and two-level ACDF (type I group), two-level CDR and one-level ACDF (type II group) and three-level ACDF. Cervical sagittal alignment parameters included cervical lordosis (CL), segment alignment (SA), T1 slope (T1S), C2-C7 sagittal vertical axis (SVA), T1S-CL, C2 slope (C2S), occipital to C2 angle (O-C2A) and segment range of motion (ROM). Postoperative complications included adjacent segment degeneration, imbalance, prosthetic subsidence and heterotopic ossification. RESULTS The three groups with a total of 106 patients were better matched in terms of demographics. Patients who underwent HS had significantly higher CL than those who underwent ACDF at 1 week, 6 months, 12 months and the final follow-up after surgery, as well as significantly better SA at 12 months and the final follow-up. There was no significant difference in T1S, SVA, T1S-CL, C2S, O-C2A or segment ROM among the three groups after surgery. The T1S-CL was significantly associated with C2S in the type I and type II groups at the preoperative and final follow-up. There was no significant difference in postoperative complications among the three groups. CONCLUSIONS Most improvements in cervical sagittal alignment (CL, SA, T1S, SVA, T1S-CL, C2S, O-C2A, and segmental ROM) were observed in all three groups postoperatively. HS was more advantageous than ACDF in the maintenance of postoperative CL and SA. Thus, three-level HS may be better for maintaining cervical curvature. The number of replacement segments differed in those who underwent HS but did not affect the correlation between T1S-CL and C2S, both of which are well balanced.
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Affiliation(s)
- Shihao Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Yuxiao Deng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Kangkang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Junbo He
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
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Goedmakers CMW, de Vries F, Bosscher L, Peul WC, Arts MP, Vleggeert-Lankamp CLA. Long-term results of the NECK trial-implanting a disc prosthesis after cervical anterior discectomy cannot prevent adjacent segment disease: five-year clinical follow-up of a double-blinded randomised controlled trial. Spine J 2023; 23:350-360. [PMID: 36396007 DOI: 10.1016/j.spinee.2022.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND CONTEXT Motion preserving anterior cervical disc arthroplasty (ACDA) in patients with cervical radiculopathy was introduced to prevent symptomatic adjacent segment disease as compared to anterior cervical discectomy and fusion (ACDF). PURPOSE To evaluate the long-term outcome in patients with cervical radiculopathy due to a herniated disc undergoing ACDA, ACDF or ACD (no cage, no plate) in terms of clinical outcome measured by the Neck Disability Index (NDI). Likewise, clinically relevant adjacent segment disease is assessed as a long-term result. STUDY DESIGN Double-blinded randomized controlled trial. PATIENT SAMPLE A total of 109 patients with one level herniated disc were randomized to one of the following treatments: ACDA, ACDF with intervertebral cage, ACD without cage. OUTCOME MEASURES Clinical outcome was measured by patients' self-reported NDI, Visual Analogue Scale (VAS) neck pain, VAS arm pain, SF36, EQ-5D, perceived recovery and reoperation rate. Radiological outcome was assessed by radiographic cervical curvature and adjacent segment degeneration (ASD) parameters at baseline and up until five years after surgery. METHODS To account for the correlation between repeated measurements of the same individual Generalized Estimated Equations (GEE) were used to calculate treatment effects, expressed in difference in marginal mean values for NDI per treatment group. RESULTS Clinical outcome parameters were comparable in the ACDA and ACDF group, but significantly worse in the ACD group, though not reaching clinical relevance. Annual reoperation rate was 3.6% in the first two years after surgery, declined to 1.9% in the years thereafter. The number of reoperations for ASD was not lower in the ACDA group, while the number of reoperations at the index level was higher after ACD, when compared to ACDF and ACDA. CONCLUSIONS A persisting absence of clinical superiority was demonstrated for the cervical disc prosthesis five years after surgery. Specifically, clinically relevant adjacent level disease was not prevented by implanting a prosthesis. Single level ACD without implanting an intervertebral device provided worse clinical outcome, which was hypothesized to be caused by delayed fusion. This stresses the need for focusing on timely fusion in future research.
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Affiliation(s)
- Caroline M W Goedmakers
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands.
| | - Floor de Vries
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands
| | - Lisette Bosscher
- Northwest Clinics, Wilhelminalaan 12, Alkmaar, 1815, NH, The Netherlands
| | - Wilco C Peul
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands
| | - Mark P Arts
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands; Spaarne Gasthuis, Spaarnepoort 1, Hoofddorp, 2134, NH, The Netherlands
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Karadağ MK, Öktenoğlu T, Başak AT, Günerbüyük C, Akgün MY, Aydın AL, Hekimoğlu M, Erbulut DU, Özer AF. Radiological and Clinical Follow-up of Alpha-D Cervical Disk Prosthesis. Indian J Orthop 2023; 57:319-324. [PMID: 36777117 PMCID: PMC9880100 DOI: 10.1007/s43465-022-00803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
Background Fusion surgery is applied to prevent segmental instability after surgery for cervical disk herniation. Motion-sparing surgeries have been developed to prevent adjacent segment disease after fusion surgery. Total disk replacement, one of these methods, has been applied in the cervical region for more than 20 years. We aimed to investigate the medium-term radiological and clinical outcomes of patients who had received Alpha-D disk prosthesis after cervical disk surgery, in terms of incidence of heterotopic ossification (HO) and other complications. Methods We included 33 patients (17 women and 16 men) diagnosed with single-level cervical disk herniation and who had received prosthesis after anterior discectomy. The average follow-up period was 36 (18-78) months. The patients were followed up postoperatively at month 4, year 1, and annually thereafter. Patients, who had Alpha-D cervical disk prosthesis (CDP) (Medikon, Turkey), were monitored via radiological (standard and dynamic X-ray) and clinical (visual analog scale [VAS] and neck disability index [NDI]) modalities. Dynamic X-ray images were evaluated by an independent radiologist for HO and prosthesis movement. Results Mean patient age was 40 ± 6.88 years. HO was observed in 7 (21.21%) patients, 6 of which were men. Significant intersex differences were noted for HO and movement rates (p = 0.039). Clinically, the mean preoperative and post-operative NDI levels were 35.4 ± 3.9 and 4 ± 2, respectively, whereas the mean pre- and post-operative VAS levels were 7 ± 1 and 1 ± 1, respectively. There was a clinically significant postoperative improvement in all the patients. However, there was no significant difference between the patients with and without HO in terms of age, operation level, and mean pre- and postoperative VAS, and postoperative NDI levels (p > 0.05). Despite the fact that there was a significant difference (p = 0.038) in favor of patients without HO in terms of mean preoperative NDI levels, this was not considered clinically significant. Conclusion In the present study, all the patients demonstrated clinically significant improvement following CDP surgery. HO rate after CDP surgery was 21.21% in the medium term, and movement was preserved in 5 of the 7 patients with partial HO. The fact that the CDP design was based on the one-to-one reproduction of the movement segment in the cervical spine, might account for the underlying cause of success. However, these good results in the medium term may change in cases with long-term clinical follow-up.
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Affiliation(s)
| | - Tunç Öktenoğlu
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | | | - Caner Günerbüyük
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Yiğit Akgün
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Hekimoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Deniz Ufuk Erbulut
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD Australia
| | - Ali Fahir Özer
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
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Bakare AA, Kolcun JPG, Piracha AZ, Moss JR, Khanna R, O'Toole JE, Deutsch H, Traynelis VC, Fessler RG. Cervical Alignment Analysis Comparing Two-Level Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion with Anterior Plate Fixation. World Neurosurg 2022; 165:e597-e610. [PMID: 35768058 DOI: 10.1016/j.wneu.2022.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study assesses cervical alignments after 2-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) with anterior plate fixation. METHODS Eighty-two patients who underwent 2-level CDA or ACDF in 2014-2019 were identified. Cervical alignment parameters were compared between the 2 cohorts. Subgroup analyses were performed to determine factors that differentiate alignment outcomes between the 2 procedures. RESULTS Although both cohorts achieved significant focal lordosis (FL) and overall cervical lordotic (CL) gains, CDA cohorts achieved significantly greater 12-month FL gain (P = 0.022). However, in a multivariate analysis controlling for preoperative variables, FL gain was no longer significant. Although the CDA cervical sagittal vertical axis (cSVA) significantly improved at 3 (P = 0.030) and 12 (P = 0.007) months, these improvements were not superior to the ACDF cSVA. Male patients undergoing CDA achieved greater 12-month CL gain. Patients undergoing CDA with body mass index >25 kg/m2 achieved greater 12-month FL gain. Patients undergoing CDA with symptom duration >12 months achieved greater FL gain at 3 and 12 months. Patients undergoing CDA with high baseline T1 slope or cSVA achieved greater 12-month cSVA reduction. Clinical outcomes were comparable between the 2 cohorts. Unlike the ACDF group, CL gain in the CDA group was significantly correlated with the cSVA reduction, which was associated with significant improvement in the Neck Disability Index, arm pain, and 12-Item Short-Form Mental Component Scores. Heterotopic ossification was not found to significantly affect patient outcome and cervical alignment in both cohorts. CONCLUSIONS ACDF and CDA are viable options for 2-level degenerative disc disease in carefully selected patients. Both approaches produced equivalent postoperative alignment changes in a 2-level operation.
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Affiliation(s)
- Adewale A Bakare
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John Paul G Kolcun
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ali Z Piracha
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonah R Moss
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent C Traynelis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
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Wang H, Wang X, Liu H, Meng Y, Guo Y, Hong Y. Risk Factors for High-Grade Heterotopic Ossification After Total Disc Replacement: A Single-Center Experience of 394 Cases. Neurosurgery 2021; 89:852-861. [PMID: 34382657 DOI: 10.1093/neuros/nyab298] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) is a common complication following total disc replacement (TDR). High-grade HO is a clinically relevant complication, however, only a few studies have evaluated risk factors for high-grade HO. OBJECTIVE To evaluate potential risk factors for HO and high-grade HO and their impact on clinical outcomes. METHODS We retrospectively reviewed patients who underwent TDR or hybrid surgery (HS) with Prestige-LP (Medtronic), Discover (Depuy), and Prodisc-C (Synthes). Clinical outcomes were assessed using Japanese Orthopaedic Association, Visual Analogue Scale, and Neck Disability Index scores. Radiological variables, including preoperative ossification, global and segmental range of motion (ROM), HO, and adjacent segment degeneration (ASD) were reviewed. RESULTS A total of 394 patients were evaluated. HO and high-grade HO occurred in 67.77% and 11.17% patients, respectively. Preoperative ossification was significantly associated with the occurrence of HO (P < .001, OR: 3.507, 95%CI: 2.211-5.562) and high-grade HO (P = .019, OR: 2.176, 95%CI: 1.137-4.166). The ROM of replacement levels and C2-7 were significantly lower in the high-grade HO group compared to those without high-grade HO: (3.80° vs 10.18°, P < .001) and (42.81° vs 54.00°, P < .001), respectively. The incidence of ASD was significantly higher in patients with high-grade HO than those without high-grade HO (22.73% vs 11.14%, P = .048). CONCLUSION Preoperative ossification was identified as a potential risk factor for HO and high-grade HO. Patients with high-grade HO had limited ROM of replacement levels and the cervical spine and had a high incidence of ASD compared to those without high-grade HO.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yingjun Guo
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Letter to the Editor concerning "Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic review and meta-analysis" by N. Hui, et al. [Eur Spine J; 2020; 29(11):2688-2700]. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1786-1787. [PMID: 33751233 DOI: 10.1007/s00586-021-06820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 02/05/2023]
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Marques C, MacDowall A, Skeppholm M, Canto Moreira N, Olerud C. Unintended fusion in cervical artificial disk replacement: a prospective study on heterotopic ossification, progression, and clinical outcome, with 5-year follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1662-1669. [PMID: 33471181 DOI: 10.1007/s00586-021-06722-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Heterotopic ossification (HO) may cause unintended fusion in artificial disk replacement (ADR), failing to preserve motion. The reported incidence of HO varies hugely. This study aimed to determine prevalence of HO, progression, predisposing factors to occurrence and to progression, and potential effect on clinical outcomes. METHODS Eighty-three patients treated with ADRs for cervical radiculopathy at one or two segments were extracted from a previously published RCT. Of the 83 patients, 59 had remaining ADR (79 implants) and sufficiently high-quality X-rays at 5 years of follow-up to allow analysis. HO was graded on plain films according to Mehren/Suchomel. Prevalence, progression, predisposing factors and effect on clinical outcome (Neck Disability Index-NDI) were analyzed. RESULTS At 2 years, HO was seen in 46/55 ADR implants (84%), severe enough to affect mobility in 27/55 (49%). At 5 years, HO was seen in 92% of 79 implants, severe in 71%. Male sex was a predisposing factor to HO. No predisposing factors to progression were identified. NDI was not affected by the severity of HO. CONCLUSION Almost all ADR implants in our study have HO at 5 years of follow-up. Male sex is a risk factor. Severe HO did not affect clinical outcome. TRIAL REGISTRATION Study registered at ISRCTN (registration number: 44347115).
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Affiliation(s)
- Catarina Marques
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Martin Skeppholm
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Nuno Canto Moreira
- Pediatric Radiology Section, Department of Clinical Neuroscience (CNS), K8, Karolinska Universitetssjukhuset Solna, Stockholm, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Ge CY, Wang J, Zhang BF, Hui H, Shan LQ, Zhao QP, Hao DJ. Spontaneous Fusion After Cervical Disc Arthroplasty: A Case Report and Literature Review. J Pain Res 2020; 13:771-776. [PMID: 32368130 PMCID: PMC7183536 DOI: 10.2147/jpr.s242646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To report a rare case of spontaneous fusion (SF) following cervical disc arthroplasty (CDA), to review the related literature, and to propose a new measure to prevent it. Methods The course of a patient with SF is described here. The potential causes, risk factors, and preventive measure of SF after CDA published in previous studies have also been reviewed and discussed. Results A 63-year-old man presented with a 6-month history of progressive neck pain and developed left C-7 radiculopathy 4 years ago. Magnetic resonance imaging revealed disc herniation at the C6–C7 levels resulting in compression of the left C-7 nerve root. The patient underwent CDA at the C6–C7 levels, during which a PRESTIGE cervical disc device was implanted. He failed to follow-up regularly as recommended postoperatively because he was completely free from the pain in his neck and left upper limb. Four years later, he was readmitted with a 2-month history of occasional neck stiffness. Plain radiographs indicated complete radiographic fusion of the C6–C7 levels with trabecular bone bridging surrounding the cervical disc prosthesis, and dynamic imaging showed no motion. He was seen at regular follow-up visits for up to 60 months without special treatment, as his symptoms of neck stiffness were minor and his symptom has not worsened since then. Conclusion SF after CDA is a rare condition that can be attributed to patient- or prosthesis-related causes, and its risk factors are diverse. SF after CDA did not affect the patient’s clinical outcome, and no special treatment was required for it. Practitioners should be aware of this rare complication and advise patients of the risks before performing CDA.
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Affiliation(s)
- Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Jing Wang
- Department of Ophthalmology, Xi'an Fourth Hospital, Xi'an 710004, Shaanxi Province, People's Republic of China
| | - Bin-Fei Zhang
- Department of Trauma Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Hao Hui
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Le-Qun Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Qin-Peng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, People's Republic of China
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