Association between anterior bone loss and anterior heterotopic ossification in hybrid surgery

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.

Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up

“…Main Complication after CDA HO and ABL were the main complications after CDA, 14,42 and were currently considered two stages of bone remodeling following CDA surgery. 43 In the present study, the incidence of HO, high-grade HO, and ABL at the arthroplasty levels did not differ significantly between the CDA and HS groups at the last follow-up. Moreover, the incidence of HO and ABL was consistent with previous studies on 1-level or contiguous 2-level CDA.…”

Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?

“…Besides, the ASD and subsidence rates were comparable among the groups. The results showed that the postoperative clinical outcomes largely depend on adequate decompression in ACDF [ 21 , 35 ]. Given this, restoring and maintaining cervical lordosis curvature is another goal that we pursue in ACDF.…”

The impact of smoking on outcomes following anterior cervical fusion-nonfusion hybrid surgery: a retrospective single-center cohort study

“…Heterotopic ossification (HO) was using the McAfee classification [ 19 ] (Table 1 ). The classification of bone loss (BL) followed a validated methodology detailed in full elsewhere, based on a classification system reported by Saleh et al in 2004 [ 20 , 21 ] (Table 2 ). For patients with two-level CDR, the more severe degree of HO and BL was recorded.…”