Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis

Chen, Jian; Wang, Xinwei; Bai, Wei; Shen, Xiantao; Yuan, Wen

doi:10.1007/s00586-011-2094-x

Cited by 100 publications

(65 citation statements)

References 34 publications

(63 reference statements)

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“…This pooled prevalence increased to 16.7 % at 24 months. The pooled prevalence of any ossification was 44.6 % at 12 months and 58.2 % at 24-month [18]. In our study, 89.2 % of patients had an ossification Cgrade I at the 5-year follow-up.…”

Section: Pain Relief Medication Consumption and Quality Of Lifesupporting

confidence: 38%

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Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

Aghayev¹,

Baerlocher²,

Hasdemir³

et al. 2012

The Spine Journal

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Background The Swiss Federal Office of Public Health demanded a nationwide HTA-registry for cervical total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISSspine registry is to generate evidence about the safety and efficiency of cervical TDA. Materials and methods Three hundred thirty-two cases treated between 3.2005 and 6.2006 who were eligible for 5 years follow-ups were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 84.6, 74.4, 50.6 and 64.8 %, respectively. Outcome measures were neck and arm pain, medication, quality of life, intraoperative and postoperative complication and revision rates. In addition, segmental mobility, ossification, adjacent and distant segment degeneration were analyzed at the 5-year follow-up. Results There was significant, clinically relevant and lasting reduction of neck (preop/postop 60/21 VAS points) and arm pain (preop/postop VAS 67/17) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.39/0.82 EQ-5D points) until the 5-year follow-up. The rates for intraoperative and early postoperative complications were 0.6 and 7.2 %, respectively. In 0.6 % an early and in 3.9 % a late revision surgery was performed. At the 5-year follow-up, the average range of motion of the mobile segments (88.2 %) was 10.2°. In 40.7 % of the patients osteophytes at least potentially affecting range of motion were seen. Conclusions Cervical TDA appeared as safe and efficient in long-term pain alleviation, consequent reduction of pain killer consumption and in improvement of quality of life. The improvement is stable over the 5 years postoperative period. The vast majority of treated segments remained mobile after 5 years, although 40.7 % of patients showed osteophytes.

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Section: Pain Relief Medication Consumption and Quality Of Lifesupporting

confidence: 38%

“…Both combined make up 40.7 % of segments. A recent meta-analysis on heterotopic ossification by Chen et al [18] showed a pooled prevalence of 11.1 % of advanced HO at the 12-month follow-up. This pooled prevalence increased to 16.7 % at 24 months.…”

Section: Pain Relief Medication Consumption and Quality Of Lifementioning

confidence: 99%

Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

Aghayev¹,

Baerlocher²,

Hasdemir³

et al. 2012

The Spine Journal

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“…More surgically related complications occurred in patients treated with fusion, largely from pseudarthrosis, dysphagia, graft donor site morbidity, and graft extrusion [1,13]. The most frequent complications of cervical disc arthroplasty included heterotopic ossification [6,22], implant wear, migration and subsidence [27], and segmental kyphosis [34]. Cervical disc arthroplasty could greatly reduce the risk of dysphagia compared with fusion.…”

Section: Discussionmentioning

confidence: 99%

“…The theoretical advantage of cervical arthroplasty has been the maintenance of segmental mobility and, thereby, reduction or avoidance of adjacent-segment degeneration and other limitations of fusion [15,27,43]. The potential disadvantages are possible wear and toxicity [27], the issue of biocompatibility [41], high incidence of heterotopic ossification [6,22], and implant migration or subsidence [35].…”

Section: Introductionmentioning

confidence: 99%

Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis

Yin

Zhou

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background As the current standard treatment for symptomatic cervical disc disease, anterior cervical decompression and fusion may result in progressive degeneration or disease of the adjacent segments. Cervical disc arthroplasty was theoretically designed to be an ideal substitute for fusion by preserving motion at the operative level and delaying adjacent level degeneration. However, it remains unclear whether arthroplasty achieves that aim. Questions/purposes We investigated whether cervical disc arthroplasty was associated with (1) better function (neck disability index, pain assessment, SF-36 mental and physical health surveys, neurologic status) than fusion, (2) a lower incidence of reoperation and major complications, and (3) a lower risk of subsequent adjacent segment degeneration. Methods We conducted a comprehensive search in MEDLINE 1 , EMBASE, and Cochrane Central Register of Controlled Trials and identified 503 papers. Of these, we identified 13 reports from 10 randomized controlled trials involving 2227 patients. We performed a meta-analysis of functional scores, rates of reoperation, and major complications. The strength of evidence was evaluated by using GRADE profiler software. Of the 10 trials, six trials including five prospective multicenter FDA-regulated studies were sponsored by industry. The mean followups of the 10 trials ranged from 1 to 5 years. Results Compared with anterior cervical decompression and fusion, cervical disc arthroplasty had better mean neck disability indexes (95% CI, À0.25 to À0.02), neurologic status (risk ratio [RR], 1.04; 95% CI, 1.00-1.08), with a reduced incidence of reoperation related to the index surgery (RR, 0.42; 95% CI, 0.22-0.79), and major surgical complications (RR, 0.45; 95% CI, 0.27-0.75) at a mean of 1 to 3 years. However, the operation rate at adjacent levels after two procedures was similar (95% CI, 0.31-1.27). The three studies with longer mean followups of 4 to 5 years also showed similar superiority of all four parameters of cervical disc arthroplasty compared with fusion. Conclusions For treating symptomatic cervical disc disease, cervical disc arthroplasty appears to provide better function, a lower incidence of reoperation related to index surgery at 1 to 5 years, and lower major complication rates compared with fusion. However, cervical disc arthroplasty did not reduce the reoperation rate attributable to adjacent segment degeneration than fusion. Further, it is unclear whether these differences in subsequent surgery including arthroplasty revisions will persist beyond 5 years.

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“…2,7,16 Recently, a high prevalence of heterotopic bone formation has also been reported for patients who have undergone spinal total disc arthroplasty. 5,10,12,15,17,20 Heterotopic ossification can negatively affect patients' daily activity if it decreases mobility of the joints and implants. 16 The incidence and clinical significance of HO after implantation of ISP devices have yet to be clarified.…”

mentioning

confidence: 99%

Incidence of heterotopic ossification after implantation of interspinous process devices

Tian¹,

Wu²,

et al. 2013

FOC

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Object This study aimed to investigate the incidence rate of heterotopic ossification (HO) after implantation of Coflex interspinous devices. Possible risk factors associated with HO were evaluated. Methods The authors retrospectively analyzed patients who had undergone single-level (L4–5) implantation of a Coflex device for the treatment of lumbar spinal stenosis. Patient data recorded were age, sex, height, weight, body mass index, smoking habits, and surgical time. Heterotopic ossification was identified through lumbar anteroposterior and lateral view radiographs. The authors developed a simple classification for defining HO and compared HO-positive and HO-negative cases to identify possible risk factors. Results Among 32 patients with follow-up times of 24–57 months, HO was detectable in 26 (81.2%). Among these 26 patients, HO was in the lateral space of the spinous process but not in the interspinous space in 8, HO was in the interspinous space but did not bridge the adjacent spinous process in 16, and interspinous fusion occurred at the level of the device in 2. Occurrence of HO was not associated with patient age, sex, height, weight, body mass index, smoking habits, or surgical time. Conclusions A high incidence of HO has been detected after implantation of Coflex devices. Clinicians should be aware of this possible outcome, and more studies should be conducted to clarify the clinical effects of HO.

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Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis

Abstract: Prognostic level III.

Cited by 100 publications

References 34 publications

Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis

Incidence of heterotopic ossification after implantation of interspinous process devices

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