1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Anterior Bone Loss after Cervical Baguera C Disc versus Bryan Disc Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8010223. [PMID: 36794256 PMCID: PMC9925247 DOI: 10.1155/2023/8010223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/07/2022] [Accepted: 01/15/2023] [Indexed: 02/08/2023]
Abstract
Objectives The objectives of this study were to identify the risk factors and incidence of anterior bone loss (ABL) after Baguera C cervical disc arthroplasty (CDA) and identify whether design differences in artificial discs affect ABL. Methods In this retrospective radiological review of patients who underwent single-level Baguera C CDA in a medical center, the extent of ABL and the following radiological parameters were recorded: global and segmental alignment angle, lordotic angle (or functional spinal unit angle), shell angle, global range of motion (ROM), and ROM of the index level. ABL at the index level was grade 0-2. Grade 0 was defined as no remodeling, grade 1 as spur disappearance or mild change in body contour, and grade 2 as obvious bone regression with Baguera C Disc exposure. Results Combining grade 1 and grade 2, ABL was found in 56 upper adjacent vertebrae and 52 lower adjacent vertebrae of the 77 patients. Only 18 patients (23.4%) had no ABL. Shell angle differed significantly between ABL grades of both the upper and lower adjacent level: 0.0° in grade 0 and 1 ABL vs. 2.0° in grade 2 ABL of the upper adjacent level (p < 0.05); and 0.0° in grade 0 and 1 ABL vs. 3.5° in grade 2 ABL of the lower adjacent level (p < 0.05). A female predominance of ABL was found. Hybrid surgery and artificial disc size were also related to ABL. Conclusions ABL is more common in Baguera C Disc arthroplasty than Bryan Disc arthroplasty. Larger shell angle was related to ABL after CDA with Baguera C Discs, which may indicate that shell angle is pivotal in determining the incidence of ABL after CDA. Females had more ABL with Baguera C Disc arthroplasty; this might be related to shorter endplate lengths as well as a smaller endplate-implant mismatch.
Collapse
|
3
|
Chen TY, Chen WH, Tzeng CY, Huang CW, Yang CC, Chen HT, Chang CC, Lee CY, Tsou HK. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J 2020; 20:1211-1218. [PMID: 32360762 DOI: 10.1016/j.spinee.2020.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is an innovative procedure launched in the early 2000s. Compared with anterior cervical discectomy and fusion, many studies show that CDA offers equivalent clinical outcomes while reducing secondary procedures and total cost. PURPOSE We sought to determine the incidence of anterior bone loss after CDA and the related biomechanical effects. STUDY DESIGN/ SETTING Retrospective chart review. PATIENT SAMPLE Patients who underwent CDA with one level Bryan Disc (Medtronic SofamorDanek, Memphis, TN, USA) at one institution. OUTCOME MEASURES Radiological measurements, including the extent of anterior bone loss, global alignment angle, shell angle, lordotic angle, mean degree of angle of the endplate with the horizontal line, global range of motion (ROM) and ROM of the index level were recorded. The grading of anterior bone loss of the index level was defined as Grade 0, no remodeling; Grade 1, spur disappearance or mild change in body contour; Grade 2, obvious bone regression with Bryan Disc exposure. METHODS Anatomical measures and ROM were compared by grade of bone loss. RESULTS Of the 121 patients included in the study, anterior bone loss was found in 53 (43.8%) on the upper adjacent level and 54 (44.6%) on the lower adjacent level. Twenty-nine patients (23.9%) had anterior bone loss in both levels. The majority of cases had Grade 1 anterior bone loss. Grade 2 bone loss was noted in the upper adjacent vertebra in only 5 patients and in 4 patients in the lower adjacent vertebra. Age, sex, operative level, and hybrid surgery had no effect on anterior bone loss. Most radiological assessments, including global alignment angle, lordotic angle, mean degree of angle of the endplate with the horizontal line, global ROM, and ROM of the index level, showed no correlation to anterior bone loss. Shell angle was found to be different in groups with or without remodeling in the upper adjacent level: 5.0 degreesin the Grade 0 group and 7.0 degrees in the Grade 1-2 group, p<.05. CONCLUSIONS Many more patients than predicted had anterior bone loss. Increasing the shell angle of the artificial disc may increase the incidence of anterior bone loss after CDA. Further study of the biomechanics following CDA should help clarify the mechanisms at work.
Collapse
Affiliation(s)
- Tse-Yu Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Wen-Hsien Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, Republic of China.
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan, Republic of China.
| | - Chi-Wei Huang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Chih-Chang Yang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Hsien-Te Chen
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, Republic of China; Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China; Spine Center, China Medical University Hospital, Taichung, Taiwan, Republic of China.
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China; Spine Center, China Medical University Hospital, Taichung, Taiwan, Republic of China; Ph.D. Degree Program of Biomedical Science and Engineering, National Chiao Tung, University, Hsinchu, Taiwan, Republic of China.
| | - Cheng-Ying Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung, Taiwan 40705 Republic of China; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, Republic of China; College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, Republic of China.
| |
Collapse
|