Is There a Relationship Between Bony Fusion After Anterior Cervical Discectomy and Fusion and Heterotopic Ossification After Cervical Disc Arthroplasty in Hybrid Surgery?

Abstract

Study Design. Retrospective analysis. Objective. The aim of this study was to investigate the relationship between bony fusion after anterior cervical discectomy and fusion (ACDF) and heterotopic ossification (HO) after cervical disc arthroplasty (CDA) in hybrid surgery (HS). Summary of Background Data. The mechanism of postoperative bone formation still remains unknown. It is considered a risk factor in CDA but is essential for a solid union in ACDF. With HS, we could directly study the mechanism and relationship of different forms of postoperative bone formation. Methods. Clinical data of 91 patients who had undergone consecutive two-level HS between January 2011 and January 2018 and with a minimum of 2-year follow-up was analyzed. HO was assessed based on McAfee's classifications, whereas fusion success was evaluated according the Food and Drug Administration approved criteria. Clinical outcomes and radiographic parameters were collected and used for the relevant comparisons. Results. HO was identified in 48.4% of patients (44/91). The fusion rates of patients in the HO group and the non-HO group at 3, 6, and 12 months postoperatively, and the final follow-up were 81.8% and 19.1%, 95.4% and 74.5%, 95.4% and 85.1%, and 97.7% and 93.6%, respectively. The fusion rates were significantly higher at 3 and 6 months after operation in the HO group than in the non-HO group (P < 0.05). Patients in both groups had significant improvements across all clinical outcomes at final follow-up. Conclusion. There was a significant relationship between bony fusion and occurrence of HO after HS, suggesting that both bony fusion and HO are reflections of individual osteogenic capacity. However, a reliable predictor of postoperative bone formation is needed in the future to guarantee a solid bony fusion after ACDF and to further take full advantage of the motion-preserving from CDA. Level of Evidence: 3

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

“…The biomechanical changes of adjacent intervertebral disc, facet joint, and stress on the instrumentation during fusion process through longitudinal study paradigm has been poorly reported. In the present study, the cervical spine-implant FE models were developed based on the CT information of a patient who underwent single-level ACDF at pre-operation, immediately post-operation, and 3 and 6 months after surgery, representing non-fusion, incomplete fusion, and complete fusion stages, respectively ( Noordhoek et al, 2019 ; He et al, 2020 ; Abudouaini et al, 2021 ). To the best of our knowledge, this is the first study to simulate the biomechanical environment at different fusion stages after ACDF based on the patient’s follow-up data.…”

Risk Factors for High-Grade Heterotopic Ossification After Total Disc Replacement: A Single-Center Experience of 394 Cases

“…Our previous study also found a significant relationship between bony fusion and HO occurrence in patients who underwent HS including TDR and ACDF. 20 We postulate that, in the context of the bone formation process, HO may be a reflection of individual osteogenic capacity and patients with more remarkable osteogenic ability have a higher incidence of HO postoperatively. Our findings showed that preoperative ossification was a potential risk factor for HO, and patients with preoperative ossification were nearly 3 times more likely to develop HO than those without preoperative ossification.…”

Our Experience in the Treatment of Vertebrobasilar Insufficiency Due to Cervical Spine Disorders

“…The disease results in disability and, if not treated, in the development of chronic discirculatory encephalopathy, cervical myelopathy, or ischemic stroke, and significant disability of the patients. In foreign practice, the relationship between a degree of cerebral neurological insufficiency and vascular lesions at various clinical and morphological stages of cervical osteochondrosis has been confirmed [2]. At the initial stages of the disease, vertebrobasilar circulatory disorders are a consequence of sympathetic (reflex) or compressive-irritative (compressionreflex) processes in the vertebral arteries.…”

“…The second stage of the disease is a consequence of the progression of histochemical and pathomorphological processes of the first stage. The loss of fixation properties by Our Experience in the Treatment of Vertebrobasilar Insufficiency Due to Cervical Spine Disorders Beslan S. Dzhilkashiev 1,2 *, Gennadiy I. Antonov 1,2 , Gennadiy E. Chmutin 1 , Keith Simfukwe 1 , Edward R. Miklashevich 2 , the annulus fibrosus results in the instability of the spinal motor segment [3], resulting in dynamic narrowing of the spinal canal, irritation, and compression of the vertebral arteries.…”