Clinical Significance of Heterotopic Ossification in Cervical Disc Replacement: A Prospective Multicenter Clinical Trial

Leung, Constant; Casey, Adrian; Goffin, Jan; Kehr, Pierre; Liebig, Klaus; Lind, Bengt; Logroscino, Carlo Ambrogio; Pointillart, Vincent

doi:10.1093/neurosurgery/57.4.759

Cited by 93 publications

(97 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7,28,39,40,42,50 Chen et al 12 report a pooled prevalence of HO of 44.6% (17.8 to 72.3%) and of advanced HO (Grade III and IV) of 11.1% (4.2 to 23.1%) after 1 year and of 58.2% (28.8% to 78.5%) and 16.7% (8.5 to 32.3%) 2 years after cTDR, respectively. Current publications tend to report higher incidences of HO with 17.8% HO 1 year after implantation of the Bryan disc (including 6.7% Grade III or IV), 34 7.9% Grade IV 2 years after Mobi-C implantation, 5 or an overall HO occurrence of 94.1%. 41 Yi et al 57 observed an overall HO rate for 3 different cTDRs of 40.6% and Brenke et al 10 found HO (Grade III and IV) in 17.4% after 18 months using fluoroscopy and even higher incidences using CT-based analysis.…”

Section: Discussionmentioning

confidence: 94%

“…9,25,36,40,54 However, there remains critical debate on cTDR mainly regarding indication, costs, and heterotopic ossification (HO). 4,10,12,34,38,41,50,52,57,58 HO may not affect clinical outcome 5,33,38,52,57 or be less relevant in the absence of clinical symptoms, 6,28 but advanced HO potentially compromises segmental mobility with an unknown impact on sagittal profile, long-term clinical results, and ASD.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

Meisel

Jurák

Antinheimo

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from −2.4° preoperatively to −6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 (clinicaltrials.gov)

show abstract

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

Meisel

Jurák

Antinheimo

et al. 2016

SPI

View full text Add to dashboard Cite

show abstract

“…Finally, 38 studies were included in the meta-analysis. [3,8–12,16–47] Figure 1 exhibits the details of screening process.…”

Section: Resultsmentioning

confidence: 99%

The prevalence of heterotopic ossification among patients after cervical artificial disc replacement

Kong

Meng

et al. 2017

Medicine

View full text Add to dashboard Cite

Background:Prevalence estimates of heterotopic ossification (HO) following cervical artificial disc replacement (ADR) varied widely in previous studies. We conducted a systematic review and meta-analysis to summarize its point prevalence.Methods:Electronic searches of PubMed, Web of Science, Embase, and Cochrane Library databases were conducted to identify studies that reported prevalence of HO. Definitions of HO and severe HO were based on McAfee grading system. Random-effects model was used to estimate the pooled prevalence. We conducted subgroup analyses according to the different length of follow-up time, and performed univariate metaregression analyses to explore the effects of potential variables on the overall prevalence.Results:A total of 38 studies were included in this study. The pooled data showed that the prevalence of HO after cervical ADR within the 1 to 2 years, 2 to 5 years, and 5 to10 years of follow-up was 38.0% (95% confidence interval [CI], 30.2%–46.5%), 52.6% (95% CI, 43.1%–61.9%), and 53.6% (95% CI, 40.0%–66.7%), respectively, while the prevalence of severe HO was 10.9% (95% CI, 9.0%–13.2%), 22.2% (95% CI, 15.5%–30.7%), and 47.5% (95% CI, 30.0%–65.8%), respectively. Follow-up time was positively associated with the prevalence of severe HO (P < .01), and the 1-month growth of mean follow-up went with 0.63% increase of severe HO.Conclusion:This meta-analysis reported data on the prevalence of HO and severe HO after cervical ADR, and provided information on its process of development. These should be useful to enable surgeons and patients to gain a better understanding of HO after cervical ADR.

show abstract

“…However, the correlation was almost marginal ( p =0.091), suggesting possible significance in a long-term follow-up. Many studies have examined risk factors for HO after cervical TDR, such as male sex, old age, longer post-operative period, prosthesis type, and preoperative calcification of longitudinal ligaments and osteophyte5,15,20,34). The reason for the high incidence of HO in our study was thought to be the difference in sex ratio (male : female=12 : 5) and prosthesis type.…”

Section: Discussionmentioning

confidence: 73%

Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

Kim

Cho

Sung

et al. 2017

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectiveTo compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria.MethodsThirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2–7 range of motion (ROM), FSU, and the adjacent segment were also checked.ResultsThe clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient’s satisfaction rates for surgery were 88.2% in group A and 88.8% in group B.ConclusionTDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient’s biomechanical characteristics and economic status should be understood and treated using the optimal procedure.

show abstract

Clinical Significance of Heterotopic Ossification in Cervical Disc Replacement: A Prospective Multicenter Clinical Trial

Abstract: There is a strong association of the occurrence of HO with subsequent loss of movement of the implanted cervical artificial disc. We have found that sex and age are two possible risk factors in the development of HO after cervical disc replacement.

Cited by 93 publications

References 11 publications

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

The prevalence of heterotopic ossification among patients after cervical artificial disc replacement

Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

Contact Info

Product

Resources

About