The Fate of Heterotopic Ossification Associated With Cervical Artificial Disc Replacement

Yi, Seong; Oh, Jae-Keun; Choi, Gwihyun; Kim, Tae Yup; Shin, Hocheol; Kh, Kim; Yoon, Doe Hyun

doi:10.1097/brs.0000000000000640

Cited by 30 publications

(23 citation statements)

References 21 publications

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“…The development of clinically significant HO is reported in 0-33% of cases at 2 years after surgery 1,21,36,37 and has been implicated as a factor in the reduction of range of movement 24 , this is supported by our results ( Figure 6). The objectivity of HO measurement has come under scrutiny, Choi 38 suggested that 'the more you look, the more you see', and variability in measurement has also been linked to bias from conflicts of interest 2 ; many studies have formalized this by using the McAfee scale 14 .…”

Section: Movement Maintenance and Radiological Changessupporting

confidence: 88%

“…The development of which has been attributed to a number of factors, including natural progression of degeneration 20 , as well an iatrogenic causes 19,21,22 , which may be aggravated by reduced movement 23 . Disk replacements vary by material and design, which affect both motion preservation and wear and tear characteristics, and consequently the risk of HO development 24 .…”

Section: Introductionmentioning

confidence: 99%

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NuNec™ Cervical Disc Arthroplasty Improves Quality of Life in Cervical Radiculopathy and Myelopathy: A 2-yr Follow-up

Turner

Choi²

2017

NEUROSURGERY

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NuNec™ cervical disk arthroplasty improves quality of life in cervical radiculopathy and myelopathy: a two-year follow-up. AbstractBACKGROUND: Anterior cervical disk replacement is an alternative to fusion for the treatment of selected cases of radiculopathy and myelopathy. We report clinical and radiological outcomes after disk replacement with the NuNec™ artificial cervical disk with subgroup analysis. RESULTS: Forty-four NuNec™ disks were implanted in 33 patients. Clinical improvements were seen in all outcomes; significant improvements on the Neck Disability Index, Euroqol 5-dimensions and physical domain of the Short Form-36 were maintained at two years. There was a mean of 4 degrees range of movement at the replacement disk level at two years, a significant reduction from baseline; there was also progression in levels of heterotopic ossification.Complications included temporary dysphagia (10%) and progression of disease requiring foraminotomy (6%); no surgery for adjacent level disease was required. There was no significant difference in the outcomes of the radiculopathy and myelopathy groups.CONCLUSION: Clinical outcomes using the NuNec™ disk replacement are comparable with other disk replacements. Although range of movement is reduced, re-operation rate is very low. 2Short title: NuNec™ improves quality of life.

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Section: Movement Maintenance and Radiological Changessupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

NuNec™ Cervical Disc Arthroplasty Improves Quality of Life in Cervical Radiculopathy and Myelopathy: A 2-yr Follow-up

Turner

Choi²

2017

NEUROSURGERY

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“…Despite the fact that this had no significant adverse effects on the clinical outcome parameters, as noted in other studies [27][28][29][30][31][32][33], efforts should be made to avoid the occurrence of HO.…”

Section: Adjacent Segment Degenerationmentioning

confidence: 90%

“…The appearance of HO right up to solid fusion (Grade 4) is a well known complication in cervical total disc replacement which can affect the motion, respectively, the function of the prosthesis [31,32,35] regardless the implant-type [7,11,17,27,28,[36][37][38][39]. The progression of HO into higher grades over time was also seen in other studies [28,32]. Up to now there is no study available that could demonstrate a significant effect of the use of NSAID in the early post-operative period to avoid or reduce the incidence of HO.…”

Section: Adjacent Segment Degenerationmentioning

confidence: 99%

Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement

et al. 2017

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“…In severe cases, HO limits range of motion, sometimes creating fusion of the segment. [16][17][18][19] Reported rates of HO following CTDR vary drastically, creating more debate and concern around the true rate and impact of HO. [20][21][22][23] The long-term effects of HO resulting in unintended fusion have not been analyzed.…”

Section: Introductionmentioning

confidence: 99%

Heterotopic Ossification After Cervical Total Disc Replacement at 7 Years—Prevalence, Progression, Clinical Implications, and Risk Factors

et al. 2018

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Background: Heterotopic ossification (HO) is a known risk following cervical total disc replacement (CTDR) surgery, but the cause and effect of HO are not well understood. Reported HO rates vary, and few studies are specifically designed to report HO. The effects on outcomes, and the risk factors for the development of HO have been hypothesized and reported in small-population, retrospective analyses, using univariate statistics.Methods: Posthoc, multiple-phase analysis of radiographic, clinical, and demographic data for CTDR as it relates to HO was performed. HO was radiographically graded for 164 one-level and 225 two-level CTDR patients using the McAfee and Mehren system. Analysis was performed to correlate HO grades to clinical outcomes and to evaluate potential risk factors for the development of HO using demographics and baseline clinical measures.Results: At 7 years, 1-level clinically relevant HO grades were 17.6% grade 3 and 11.1% grade 4. Two-level clinically relevant HO grades, evaluated using the highest patient grade, were 26.6% grade 3 and 10.8% grade 4. Interaction between HO and time revealed significance for neck disability index (NDI; P ¼ .04) and Visual Analog Scale (VAS) neck pain (P ¼ .02). When analyzed at each time point NDI was significant at 48-84 months and VAS neck at 60 months. For predictors 2 analyses were run; odds ratios indicated follow-up visit, male sex, and preoperative VAS neck pain are related to HO development, whereas hazard ratios indicated male sex, obesity, endplate coverage, levels treated, and preoperative VAS neck pain.Conclusions: This is the largest study to report HO rates, and related outcomes and risk factors. To develop an accurate predictive model, further large-scale analyses need to be performed. Based on the results reported here, clinically relevant HO should be more accurately described as motion-restricting HO until a definitive link to outcomes has been established.

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The Fate of Heterotopic Ossification Associated With Cervical Artificial Disc Replacement

Abstract: 3.

Cited by 30 publications

References 21 publications

NuNec™ Cervical Disc Arthroplasty Improves Quality of Life in Cervical Radiculopathy and Myelopathy: A 2-yr Follow-up

NuNec™ Cervical Disc Arthroplasty Improves Quality of Life in Cervical Radiculopathy and Myelopathy: A 2-yr Follow-up

Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement

Heterotopic Ossification After Cervical Total Disc Replacement at 7 Years—Prevalence, Progression, Clinical Implications, and Risk Factors

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