The Effect of Preoperative Cervical Spondylosis on Heterotopic Ossification After Cervical Disc Replacement

Abstract

Study Design Retrospective cohort study. Objectives This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR). Methods The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors. Results 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up ( P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group ( P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO ( P = .009). No significant degenerative factors related to the formation of AHO were found. Conclusions Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.

Finite element analysis of optimized novel additively manufactured non-articulating prostheses for cervical total disc replacement

“…Due to the load-bearing capabilities and complexity of motion exposure to daily activities, the importance of evaluating the material characteristics of the prosthesis intended to replace the disc cannot be underestimated. Furthermore, current failures associated with existing implants, such as heterotopic ossification, insufficient stiffness, dislocation, wear and improper ICR further buttress the need for assessing the mechanical behavior of a material proposed to replace the disc ( Virk et al, 2021 ; Shen et al, 2021 ; Shen et al, 2022 ; Cao et al, 1976 ; Parish et al, 2020 ). Thus, an appropriate material attribute design using a PE core and PCU fiber jacket with adequate native geometry could represent a suitable candidate for replacing the disc.…”

“…The preservation of physiologic motion at the treated level leads to longevity of the facet joints and decreases the adjacent segment degeneration rate, which would otherwise lead to additional revision surgery ( Bhattacharya et al, 2019 ; Rajakumar et al, 2017 ; Yang et al, 2017 ). Ball-and-socket TDR have been more popular than other designs in recent years, but their potential disadvantages include polyethylene (PE) wear, heterotrophic ossification, increased contact forces, and disc subsidence and migration ( Virk et al, 2021 ; Shen et al, 2021 ; Shen et al, 2022 ; Cao et al, 1976 ; Parish et al, 2020 ). A new-generation prosthesis with a compressible central core allows for six kinematic degrees of freedom and mimics normal biomechanics has been developed and used ( Patwardhan et al, 2012 ; Phillips et al, 2021 ; Oltulu et al, 2019 ).…”

Surgical Treatment of Cervical Spondylotic Myelopathy

“…The main manifestation of HO is osteogenesis which occurs outside the skeletal system. The incidence of HO was demonstrated to be 60% after CDR [78]. Although HO usually does not cause obvious symptoms that require secondary surgery [79], severe HO may give rise to the fusion of surgical segments, which is contrary to the purpose of CDR surgery to preserve the mobility of the cervical spine [80].…”