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Sheng XQ, Wu TK, Liu H, Meng Y. Incidence of Heterotopic Ossification at 10 years After Cervical Disk Replacement: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2023; 48:E203-E215. [PMID: 37036304 PMCID: PMC10249612 DOI: 10.1097/brs.0000000000004674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/09/2023] [Indexed: 04/11/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE This study aimed to assess the incidence of heterotopic ossification (HO) 10 years after cervical disk replacement (CDR). SUMMARY OF BACKGROUND DATA HO is a common complication after CDR and may limit the range of motion of the artificial disk. As HO usually progresses slowly, a long-term follow-up is required to better understand its incidence. In recent years, the increasing number of original articles reporting 10-year outcomes gives us the opportunity to better understand the long-term incidence of HO. MATERIALS AND METHODS We searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The incidence of HO was pooled, and subgroup analysis was performed. Meta-regression analyses were conducted to identify factors contributing to heterogeneity. RESULTS Eleven studies with at least 10 years of follow-up comprising 1140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI, 60%-81%) at 10 years postoperatively, 60% (95% CI, 44%-75%) at five or six years postoperatively, and 50% (95% CI, 27%-72%) at one or two years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI, 29%-45%), and mild HO (grade 1 to 2) was 30% (95% CI, 17%-44%) at 10 years of follow-up. Pooled range of motion decreased from 8.59° before surgery to 7.40° 10 years after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type. The earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis. CONCLUSIONS This is the first meta-analysis providing detailed information on the pooled 10-year incidence of HO after CDR. The incidence of HO seems to increase with the length of follow-up. LEVEL OF EVIDENCE 3.
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Huang CW, Tsou HK, Chen WH, Tsai JC, Chung KC, Lin RH, Chen TY, Tzeng CY. The residual exposed endplate ratio is predictive of posterior heterotopic ossification after cervical Bryan disc arthroplasty. J Clin Neurosci 2023; 114:97-103. [PMID: 37352684 DOI: 10.1016/j.jocn.2023.06.005] [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: 05/12/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES Heterotopic ossification (HO), a major cause of dysfunction after disc arthroplasty (CDA). The aim of this study was to determine the cut value of the residual exposed endplate (REE) ratio and to predict the development of posterior HO after Bryan CDA. METHODS This retrospective study investigated the relationship between the REE ratio and posterior HO formation after Bryan CDA. Consecutive adult patients who underwent 1- or 2-level Bryan CDA by a single neurosurgeon between 2006 and 2016 with at least two years follow-up were included. Postoperative radiographic analysis and measurement were performed to obtain the REE ratio and the HO grade. RESULTS Of 249 patients with 384 surgical levels who underwent Bryan CDA during the study period, 114 (45.8 %) received 1-level CDA and 135 (54.2 %) received 2-level CDA. Lateral radiographs showed that 169 implants (44 %) had posterior HOs in all grades after two years or more of follow up and 14 implants (3.64 %) had severe HO (McAfee grades 3 and 4). In 329 implants (85.7 %), a comparison of radiographs to CT examination of HO grading showed a substantial relationship. Using area under the curve (AUC) analysis, a REE ratio >9 %, with 65.1 % sensitivity and 86.5 % specificity, was the cut point for posterior HO formation. CONCLUSIONS REE is highly correlated with the development of postoperative posterior HO after Bryan CDA, regardless of the level of implantation. An undersized implant causing a REE ratio >9 % is a predictor of postoperative posterior HO formation after cervical Bryan CDA.
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Affiliation(s)
- Chih-Wei Huang
- Department of Neurosurgery,Neurological Institute,Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, ROC; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC; College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, ROC
| | - Wen-Hsien Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC; Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC; Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Jen-Chieh Tsai
- Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC
| | - Kai-Chen Chung
- Department of Neurosurgery,Neurological Institute,Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Tse-Yu Chen
- Department of Neurosurgery,Neurological Institute,Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chung-Yuh Tzeng
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, ROC; Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC; Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC.
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Chang CJ, Liu YF, Hsiao YM, Huang YH, Liu KC, Lin RM, Lin CL. Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis. J Neurosurg Spine 2022; 37:569-578. [PMID: 35453110 DOI: 10.3171/2022.2.spine211500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) has long been regarded as a gold standard in the treatment of cervical myelopathy. Subsequently, cervical artificial disc replacement (c-ADR) was developed and provides the advantage of motion preservation at the level of the intervertebral disc surgical site, which may also reduce stress at adjacent levels. The goal of this study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for cervical spondylotic myelopathy (CSM). METHODS A systematic literature review and meta-analysis were performed using the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from database inception to November 21, 2021. The authors compared Neck Disability Index (NDI), SF-36, and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyze outcomes after identifying articles that met study inclusion criteria. RESULTS More surgical time was consumed in the c-ADR surgery (p = 0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p = 0.04). Patients who had undergone c-ADR tended to have better NDI scores (p = 0.02) and SF-36 scores (p = 0.001). Comparable outcomes in terms of JOA scores (p = 0.24) and neurological success rate (p = 0.12) were noted after the surgery. There was no significant between-group difference in the overall complication rates (c-ADR: 18% vs ACDF: 25%, p = 0.17). However, patients in the ACDF group had a higher reoperation rate than patients in the c-ADR group (4.6% vs 1.5%, p = 0.02). CONCLUSIONS At the midterm follow-up after treatment of CSM, better functional outcomes as reflected by NDI and SF-36 scores were noted in the c-ADR group than those in the ACDF group. c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications. A large sample size with long-term follow-up studies may be required to confirm these findings in the future.
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Affiliation(s)
- Chao-Jui Chang
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yuan-Fu Liu
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 3Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin
| | - Yu-Meng Hsiao
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Yi-Hung Huang
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 5Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City
| | - Keng-Chang Liu
- 6Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi
- 7School of Medicine, Tzu Chi University, Hualien City
| | - Ruey-Mo Lin
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Cheng-Li Lin
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 8Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan; and
- 9Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan
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Effects of endplate coverage and intervertebral height change on heterotopic ossification following cervical disc replacement. J Orthop Surg Res 2021; 16:693. [PMID: 34823557 PMCID: PMC8614029 DOI: 10.1186/s13018-021-02840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background Heterotopic ossification (HO) is a common complication after cervical disc replacement (CDR). Biomechanical factors including endplate coverage and intervertebral disc height change may be related to HO formation. However, there is a dearth of quantitative analysis for endplate coverage, intervertebral height change and their combined effects on HO. Methods Patients who underwent single-level or two-level CDR with Prestige-LP were retrospectively reviewed. Clinical outcomes were evaluated through Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and visual analogue scale (VAS) score. Radiological data, including the prosthesis-endplate depth ratio, intervertebral height change, posterior heterotopic ossification (PHO) and angular parameters, were collected. Logistic regression analysis was used to identify the potential risk factors. Receiver operating characteristic curves were plotted and the cut-off values of each potential factors were calculated. Results A total of 138 patients with 174 surgical segments were evaluated. Both the prosthesis-endplate depth ratio (P < 0.001) and post-operative disc height change (P < 0.001) were predictive factors for PHO formation. The area under the curve (AUC) of the prosthesis-endplate depth ratio, disc height change and their combined effects represented by the combined parameter (CP) were 0.728, 0.712 and 0.793, respectively. The risk of PHO significantly increased when the prosthesis-endplate depth ratio < 93.77% (P < 0.001, OR = 6.909, 95% CI 3.521–13.557), the intervertebral height change ≥ 1.8 mm (P < 0.001, OR = 5.303, 95% CI 2.592–10.849), or the CP representing the combined effect < 84.88 (P < 0.001, OR = 10.879, 95% CI 5.142–23.019). Conclusions Inadequate endplate coverage and excessive change of intervertebral height are both potential risk factors for the PHO after CDR. Endplate coverage less than 93.8% or intervertebral height change more than 1.8 mm would increase the risk of PHO. The combination of these two factors may exacerbate the non-uniform distribution of stress in the bone-implant interface and promote HO development.
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Wang H, Meng Y, Liu H, Wang X, Hong Y. The impact of smoking on outcomes following anterior cervical fusion-nonfusion hybrid surgery: a retrospective single-center cohort study. BMC Musculoskelet Disord 2021; 22:612. [PMID: 34243728 PMCID: PMC8272305 DOI: 10.1186/s12891-021-04501-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is mixed evidence for the impact of cigarette smoking on outcomes following anterior cervical surgery. It has been reported to have a negative impact on healing after multilevel anterior cervical discectomy and fusion, however, segmental mobility has been suggested to be superior in smokers who underwent one- or two-level cervical disc replacement. Hybrid surgery, including anterior cervical discectomy and fusion and cervical disc replacement, has emerged as an alternative procedure for multilevel cervical degenerative disc disease. This study aimed to examine the impact of smoking on intermediate-term outcomes following hybrid surgery. METHODS Radiographical and clinical outcomes of 153 patients who had undergone continuous two- or three-level hybrid surgery were followed-up to a minimum of 2-years post-operatively. The early fusion effect, 1-year fusion rate, the incidence of bone loss and heterotopic ossification, as well as the clinical outcomes were compared across three smoking status groups: (1) current smokers; (2) former smokers; (3) nonsmokers. RESULTS Clinical outcomes were comparable among the three groups. However, the current smoking group had a poorer early fusion effect and 1-year fusion rate (P < 0.001 and P < 0.035 respectively). Both gender and smoking status were considered as key factors for 1-year fusion rate. Upon multivariable analysis, male gender (OR = 6.664, 95% CI: 1.248-35.581, P = 0.026) and current smoking status (OR = 0.009, 95% CI: 0.020-0.411, P = 0.002) were significantly associated with 1-year fusion rate. A subgroup analysis demonstrated statistically significant differences in both early fusion process (P < 0.001) and the 1-year fusion rate (P = 0.006) across the three smoking status groups in female patients. Finally, non-smoking status appeared to be protective against bone loss (OR = 0.427, 95% CI: 0.192-0.947, P = 0.036), with these patients likely to have at least one grade lower bone loss than current smokers. CONCLUSIONS Smoking is associated with poor outcomes following hybrid surgery for multilevel cervical disc disease. Current smokers had the poorest fusion rate and most bone loss, but no statistically significant differences were seen in clinical outcomes across the three groups.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China.
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Sichuan, 610041, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Sichuan, China.,West China School of Nursing, West China Hospital, Sichuan University, Sichuan, China
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Ebinu JO, Ramanathan D, Kurtz SM, Lawandy S, Kim KD. Periprosthetic Osteolysis in Cervical Total Disc Arthroplasty: A Single Institutional Experience. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
ABSTRACT
BACKGROUND
Cervical disc arthroplasty (CDA) affords an excellent alternative to cervical fusion for the treatment of symptomatic patients with degenerative disc disease. As more surgeons perform CDAs, an understanding of the complications associated with this technique is crucial. Periprosthetic osteolysis (PO) is a rare potential complication associated with CDA.
OBJECTIVE
To highlight potential complications associated with CDA.
METHODS
A retrospective chart review of patients who underwent CDA at our institution was performed. Patient outcomes and relevant clinical and radiographical data were analyzed in addition to associated complications. Explanted devices were subjected to macroscopic and microscopic analyses.
RESULTS
A total of 88 patients were included: 68 patients underwent 1-level CDA and 20 patients had 2-level CDA. Implants used in this series included Mobi-C (Zimmer Biomet), Prestige LP (Medtronic), Secure C (Globus), Advent (Orthofix), and ProDisc C (DePuy). One patient demonstrated symptoms of myeloradiculopathy that correlated with radiographical periprosthetic osteolysis and required surgical intervention in the form of disc explantation, corpectomy, and cervical instrumented fusion. Device retrieval analysis demonstrated evidence of elevated oxidation levels and increased wear in the presence of high concentrations of metal ions and debris in the surrounding tissue. The tissue did not exhibit any immune response, infection, or acute inflammation.
CONCLUSION
PO is a potential complication of CDA that occurs irrespective of the type of implant used. We describe its occurrence and management and highlight the importance of being aware of this understated phenomenon.
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Affiliation(s)
- Julius O Ebinu
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Dinesh Ramanathan
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Steven M Kurtz
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shokry Lawandy
- School of Medicine, California University of Science and Medicine, Riverside, California, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
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Xu S, Ou Y, Du X, He B, Li Y, Yu H. Heterotopic Ossification After Prestige-LP Cervical Disc Arthroplasty Is Related to Insufficient Sagittal Coverage of the Endplate By the Prosthesis. Med Sci Monit 2021; 27:e929890. [PMID: 33750753 PMCID: PMC7995920 DOI: 10.12659/msm.929890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Heterotopic ossification (HO) is a major complication after cervical disc arthroplasty (CDR) that has attracted the attention of spine surgeons. There remains a great deal of controversy regarding the surgical risk factors. The present study investigated the correlation between insufficient sagittal coverage of the prosthesis-endplate and HO after CDR and explored strategies to prevent it. Material/Methods We included 73 patients who underwent Prestige-LP arthroplasty. Patients were divided into HO and non-HO groups. Related data, including radiological, clinical information, were collected. HO was graded using the McAfee classification. Analysis was performed to correlate HO to the surgical segmental range of motion (ROM) at last follow-up. To evaluate the insufficient sagittal coverage of the prosthesis-endplate and other factors for developing HO, receiver operating characteristic (ROC) curves were analyzed for insufficient sagittal coverage. Results Among 73 patients, 24 patients had HO at the last follow-up (HO incidence: 32.9%). The ROM in the HO group was significantly lower (P<0.001). The insufficient sagittal coverage of the upper and lower prosthesis-endplate, the height of intervertebral space, and the preoperative and postoperative ROM were related to HO (P<0.05). Multivariate logistic regression analysis showed that only insufficient sagittal coverage of the upper prosthesis-endplate was related to HO (P=0.023), and ROC curve analysis revealed that HO was more likely to occur with insufficient sagittal coverage distance ≥2.5 mm. Conclusions HO after CDR causes a reduction in ROM, the occurrence of which is associated with insufficient sagittal coverage of the prosthesis-endplate. HO was more likely to occur with insufficient sagittal coverage distance ≥2.5 mm.
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Affiliation(s)
- Shuai Xu
- Department of Orthopedics, The Bishan Hospital of Chongqing, Chongqing, China (mainland)
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Yuanqiang Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Haoyang Yu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
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Wang XF, Meng Y, Liu H, Hong Y, Wang BY. Anterior bone loss after cervical disc replacement: A systematic review. World J Clin Cases 2020; 8:5284-5295. [PMID: 33269261 PMCID: PMC7674730 DOI: 10.12998/wjcc.v8.i21.5284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anterior bone loss (ABL) is a relatively easily neglected condition after cervical disc replacement (CDR). Whether this phenomenon is a radiological anomaly or a complication remains controversial. Several studies have reported the clinical characteristics of ABL and speculated on the pathogenic mechanism based on a certain type of artificial disc, while the overall understanding of ABL is lacking.
AIM To describe the prevalence, impacts, and risk factors of ABL after CDR.
METHODS We searched the PubMed, Cochrane Library, and Excerpta Medica databases using the terms “bone loss” or “bone remodeling” or “bone absorption” or “osteolysis” or “implant loosening” or “implant migration” or “hypersensitivity” or “hyperreactivity”, “cervical disc replacement” or “cervical disc arthroplasty” or “total disc replacement”. Eligible manuscripts on the prevalence and impacts of ABL were reviewed by the authors. Data extraction was performed using an established extraction form. The results of the included studies were described narratively.
RESULTS Six studies met the inclusion and exclusion criteria. One was a prospective study and the others were retrospective studies. A total of 440 patients with 536 segments were included. The artificial cervical discs included Bryan, Baguera-C, Discocerv, and Mobi-C. The prevalence of ABL ranged from 3.13% to 91.89%, with a combined overall prevalence of 41.84%. ABL occurred within 6 mo and stopped 12 mo after surgery. Several cases were noted to have a self-healing process. Severe ABL resulted in segmental kyphosis, implant subsidence, and persistent neck pain. ABL may be related to heterotopic ossification. Multilevel surgery may be one of the risk factors for ABL.
CONCLUSION ABL is a common condition after CDR. The underlying mechanisms of ABL may include stress concentration and injury to nutrient vessels. ABL should be considered a complication after CDR as it was associated with neck pain, implant subsidence, and heterotopic ossification.
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Affiliation(s)
- Xiao-Fei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Hong
- Department of Anesthesia and Operation Center/West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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He J, Liu H, Wu T, Ding C, Huang K, Hong Y, Wang B. Association between anterior bone loss and anterior heterotopic ossification in hybrid surgery. BMC Musculoskelet Disord 2020; 21:664. [PMID: 33032562 PMCID: PMC7545925 DOI: 10.1186/s12891-020-03664-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hybrid surgery (HS) has become an alternative procedure for the treatment of multilevel cervical degenerative disc disease with satisfactory outcomes. However, some adverse outcomes have recently emerged, such as heterotopic ossification (HO) and anterior bone loss (ABL). Furthermore, HO was found mostly located in the posterior and lateral of the cervical intervertebral disc space. The mechanism of anterior heterotopic ossification (AHO) formation may be different, and its relationship with ABL was uncertain. Methods Radiographical and clinical outcomes of ninety-seven patients who had undergone contiguous two-level HS between December 2010 and December 2017 and with a minimum of 2-year follow-up were analyzed. Postoperative radiographs were evaluated and compared to the initial postoperative films to determine the incidence of ABL and AHO. Results The overall incidence rate of ABL was 44.3% (43/97). It was identified in 70.6% of AHO cases (33.3% mild, 41.7% moderate, 25.0% severe) and 38.8% of non-AHO cases (38.7% mild, 45.2% moderate, 16.1% severe). A significant association between ABL and AHO occurrence was found (P = 0.016). There was no significant difference in prosthesis–endplate depth ratio or disc space angle change between the AHO group and the non-AHO group (P > 0.05). Compared with data preoperatively, clinical outcome scores significantly improved after surgery in both the AHO and non-AHO groups, with no significant differences between the two groups (P > 0.05). Conclusion ABL was common in HS, and it related to AHO. The formation of AHO could be an integral part of postoperative bone remodeling, as well as ABL.
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Affiliation(s)
- Junbo He
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Kangkang Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China.
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Zhou F, Li S, Zhao Y, Zhang Y, Ju KL, Zhang F, Pan S, Sun Y. Quantitative analysis of the correlation between preoperative cervical degeneration and postoperative heterotopic ossification after cervical disc replacement: minimum 10-year follow-up data. J Neurosurg Spine 2020; 33:674-679. [PMID: 32679563 DOI: 10.3171/2020.4.spine191303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to identify factors that may be useful for quantifying the amount of degenerative change in preoperative patients to identify ideal candidates for cervical disc replacement (CDR) in patients with a minimum of 10 years of follow-up data. METHODS During the period from December 2003 to August 2008, 54 patients underwent CDR with a Bryan cervical disc prosthesis performed by the same group of surgeons, and all of the patients in this group with at least 10 years of follow-up data were enrolled in this retrospective analysis of cases. Postoperative bone formation was graded in radiographic images by using the McAfee classification for heterotopic ossification. Preoperative degeneration was evaluated in radiographs based on a quantitative scoring system. After univariate analysis, the authors performed multifactor logistic regression analysis to identify significant factors. To determine the cutoff points for the significant factors, a receiver operating characteristic (ROC) curve analysis was conducted. RESULTS Study patients had a mean age of 43.6 years and an average follow-up period of 120.3 months. The patients as a group had a 68.2% overall incidence of bone formation. Based on univariate analysis results, data for patient sex, disc height, and the presence of anterior osteophytes and endplate sclerosis were included in the multivariate analysis. According to the analysis results, the identified independent risk factors for postoperative bone formation included disc height, the presence of anterior osteophytes, and endplate sclerosis, and according to a quantitative scoring system for degeneration of the cervical spine based on these variables, the ROC curve indicated that the optimal cutoff scores for these risk factors were 0.5, 1.5, and 1.5, respectively. CONCLUSIONS Among the patients who were followed up for at least 10 years after CDR, the incidence of postoperative bone formation was relatively high. The study results indicate that the degree of degeneration in the target level before surgery has a positive correlation with the incidence of postoperative ossification. Rigorous indication criteria for postoperative ossification should be applied in patients for whom CDR may be a treatment option.
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Affiliation(s)
- Feifei Zhou
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Shuyang Li
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yanbin Zhao
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yilong Zhang
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | | | - Fengshan Zhang
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Shengfa Pan
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
| | - Yu Sun
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
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Wu TK, Liu H, Ding C, Rong X, He JB, Huang KK, Hong Y, Wang BY. Effect of preoperative segmental range of motion on patient outcomes in cervical disc arthroplasty. BMC Musculoskelet Disord 2020; 21:457. [PMID: 32660463 PMCID: PMC7359220 DOI: 10.1186/s12891-020-03419-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/12/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cervical disc arthroplasty (CDA) has been demonstrated, in clinical trials, as an effective and safe treatment for patients diagnosed with radiculopathy and/or myelopathy. However, the current CDA indication criteria, based on the preoperative segmental range of motion (ROM), comprises a wide range of variability. Although the arthroplasty level preserved ROM averages 7°-9° after CDA, there are no clear guidelines on preoperatively limited or excessive ROM at the index level, which could be considered as suitable for CDA. Methods This was a retrospective study of patients who underwent CDA between January 2008 and October 2018 using Prestige-LP discs in our hospital. They were divided into the small-ROM (≤5.5°) and the large-ROM (> 12.5°) groups according to preoperatively index-level ROM. Clinical outcomes, including the Japanese Orthopedics Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores, were evaluated. Radiological parameters, including cervical lordosis, disc angle (DA), global and segmental ROM, disc height (DH), and complications were measured. Results One hundred and twenty six patients, with a total of 132 arthroplasty segments were analyzed. There were 64 patients in the small-ROM and 62 in the large-ROM group. There were more patients diagnosed with cervical spondylosis in the small-ROM than in the large-ROM group (P = 0.046). Patients in both groups had significantly improved JOA, NDI, and VAS scores after surgery, but the intergroup difference was not significant. Patients in the small-ROM group had dramatic postoperative increase in cervical lordosis, global and segmental ROM (P < 0.001). However, there was a paradoxical postoperative decrease in global and segmental ROM in the large-ROM group postoperatively (P < 0.001). Patients in the small-ROM group had lower preoperative DH (P = 0.012), and a higher rate of postoperative heterotopic ossification (HO) (P = 0.037). Conclusion Patients with preoperatively limited segmental ROM had severe HO, and achieved similar postoperative clinical outcomes as patients with preoperatively excessive segmental ROM. Patients with preoperatively limited segmental ROM showed a postoperative increase in segmental mobility, which decreased in patients with preoperatively excessive segmental ROM.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Jun-Bo He
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Kang-Kang Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, Sichuan, China.
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Hui N, Phan K, Cheng HMK, Lin YH, Mobbs RJ. Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic review and meta-analysis. 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 2020; 29:2688-2700. [DOI: 10.1007/s00586-020-06400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 12/23/2022]
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Gornet MF, Lanman TH, Burkus JK, Dryer RF, McConnell JR, Hodges SD, Schranck FW, Ma G. Occurrence and clinical implications of heterotopic ossification after cervical disc arthroplasty with the Prestige LP Cervical Disc at 2 contiguous levels. J Neurosurg Spine 2020; 33:41-50. [PMID: 32168483 DOI: 10.3171/2020.1.spine19816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to assess the impact of heterotopic ossification (HO) on clinical outcomes and angular range of motion (ROM) after cervical disc arthroplasty (CDA) performed with the Prestige LP Cervical Disc (Prestige LP disc) at 2 levels. METHODS HO was assessed and graded from 0 to IV for increasing severity on lateral neutral radiographs at each visit in 209 patients who underwent implantation of Prestige LP discs at 2 cervical levels in a clinical trial with extended 10-year follow-up. ROM was compared by using HO grade, and clinical outcomes were compared between HO subgroups (grade 0-II vs III/IV) based on HO severity at 2 and 10 years after surgery. RESULTS The grade III/IV HO incidence at either or both index levels was 24.2% (48/198) at 2 years and 39.0% (57/146) at 10 years. No statistical difference was found in overall success; neurological success; or Neck Disability Index (NDI), neck pain, arm pain, or SF-36 Physical Component Summary (PCS) scores between the HO subgroups (grade 0-II vs III/IV) at either 2 or 10 years. The cumulative rate of possible implant-related adverse events (AEs) was higher in patients having grade III/IV HO at 2 years (56.3%) and 10 years (47.8%) compared with those having grade 0-II HO at 2 years (24.4%) and 10 years (17.9%), specifically in 2 subcategories: spinal events and HOs reported by the investigators. No statistical difference was found between the HO subgroups in possible implant-related serious AEs or secondary surgeries at the index or adjacent levels. The average angular ROMs at index levels were lower in subjects with higher-grade HO at 2 and 10 years. The average ROMs at the superior level were 8.8°, 6.6°, 3.2°, and 0.3°, respectively, for the HO grade 0/I, II, III, and IV groups at 10 years, and 7.9°, 6.2°, 3.7°, and 0.6°, respectively, at the inferior level. CONCLUSIONS Radiographically severe (grade III or IV) HO after CDA with the Prestige LP disc at 2 levels did not significantly affect efficacy or safety outcomes (severe AEs or secondary surgeries). However, severe HO, particularly grade IV HO, significantly limited ROM, as expected.
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Affiliation(s)
| | - Todd H Lanman
- 2Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Scott D Hodges
- 6Center for Sports Medicine & Orthopaedics, Chattanooga, Tennessee
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Implant Design and the Anchoring Mechanism Influence the Incidence of Heterotopic Ossification in Cervical Total Disc Replacement at 2-year Follow-up. Spine (Phila Pa 1976) 2019; 44:1471-1480. [PMID: 31568185 DOI: 10.1097/brs.0000000000003098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A nonrandomized, prospective, and single-center clinical trial. OBJECTIVE The aim of this study was to determine whether the prosthesis design, and especially changes in the primary anchoring mechanism between the keel-based ProDisc C and the spike-based ProDisc Vivo, affects the frequency of heterotopic ossification (HO) formation over time. SUMMARY OF BACKGROUND DATA The occurrence of motion-restricting HO as well as underlying risk factors has so far been a widely discussed, but not well understand phenomenon. The anchoring mechanism and the opening of the anterior cortex may be possible causes of this unwanted complication. METHODS Forty consecutive patients treated with the ProDisc C and 42 consecutive patients treated with the ProDisc Vivo were compared with respect to radiological and clinical outcome, with 2 years of follow-up. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and arm and neck pain self-assessment questionnaires. Radiological outcomes included the segmental lordosis and range of motion (ROM) of the index-segment as well as the occurrence of HO. RESULTS The clinical outcome parameters improved in both groups significantly. [ProDisc C: VAS arm and neck pain from 6.3 and 6.2 preoperatively to 0.7 and 1.3; NDI from 23.0 to 3.7; ProDisc Vivo: VAS arm and neck pain from 6.3 and 4.9 to 1.4 and 1.6, NDI from 34.1 to 8.7; 2-year follow-up (FU)]. The ProDisc Vivo cohort demonstrated a significantly lower incidence of HO than the ProDisc C group at 1-year FU (P = 0.0005) and 2-year FU (P = 0.005). Specifically, high-grade HO occurred in 9% versus 31%. CONCLUSION These findings demonstrate that prosthesis designs that allow primary anchoring without violation of the cortical surface help to reduce the incidence of severe ossification, possibly affecting the functionality and mobility of the artificial disc device over of time. LEVEL OF EVIDENCE 3.
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Heterotopic ossification is related to change in disc space angle after Prestige-LP cervical disc arthroplasty. 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 2019; 28:2359-2370. [DOI: 10.1007/s00586-019-06053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/25/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
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Evidence-based use of arthroplasty in cervical degenerative disc disease. INTERNATIONAL ORTHOPAEDICS 2019; 43:767-775. [PMID: 30623197 DOI: 10.1007/s00264-018-04281-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/26/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical disc arthroplasty (CDA) was developed to decrease the rate of symptomatic adjacent-level disease while preserving motion in the cervical spine. METHODS The objectives of this paper are to provide criteria for proper patient selection as well as to present a comprehensive literature review of the current evidence for CDA, including randomized studies, the most recent meta-analysis findings, and long-term follow-up clinical trials as well. RESULTS Currently, there are several prospective randomized controlled studies of level I of evidence attesting to the safety and efficacy of CDA in the management of cervical spondylotic disease (CSD) for one- or two-level degenerative diseases. These as well as recent meta-analyses suggest that CDA is potentially similar or even superior to anterior cervical discectomy and fusion (ACDF) when considering several outcomes, including dysphagia and re-operation rate over medium-term follow-up. Less robust studies have also reported satisfactory clinical and radiological outcomes of CDA for hybrid procedures (ACDF combined with CDA), non-contiguous disease, and even for multilevel disease (more than 2 levels). CONCLUSIONS Based on this evidence we conclude that CDA is a safe and effective alternative to ACDF in properly selected patients for one- or two-level diseases. Defining superiority of specific implants and detailing optimal surgical indications will require further well-designed long-term studies.
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