Heterotopic Ossification After Prestige-LP Cervical Disc Arthroplasty Is Related to Insufficient Sagittal Coverage of the Endplate By the Prosthesis

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.

Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients

“…Although there is still no effective way of reducing the risk T. Takami et al of HO long after ACDR, Xu et al suggested that the occurrence of HO after ACDR may be related to insufficient sagittal coverage of the endplate by CAD. 68) Migration or dislocation of CAD after ACDR is a rare complication but may result in serious problems once it occurs. Previous reports of such complications are limited to case reports.…”

Incidence of Heterotopic Ossification at 10 years after Cervical Disc Replacement

“…Therefore, we conducted subgroup analyses and meta-regression for these parameters. Furthermore, a high degree of ossification before surgery, 34 insufficient endplate coverage of the prosthesis, [35][36][37] intervertebral space height change before and after surgery ≥ 1.8 mm, 35 excessive intervertebral space distraction, 38 and disk space angle change during operation > 5°3 9 may lead to higher incidences of HO. The above patient characteristics and surgical details may vary between studies.…”