The Risk of Adjacent-Level Ossification Development After Surgery in the Cervical Spine

Kim, Hee Jin; Kelly, Michael P.; Ely, Claire G.; Riew, K. Daniel; Dettori, Joseph R

doi:10.1097/brs.0b013e31826cb8f5

Cited by 54 publications

(39 citation statements)

References 10 publications

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“…Age, sex, levels of surgery, indications for surgery, and the carpentry of arthroplasty were the reported factors that could affect the formation of HO after cervical arthroplasty. 6,18,24,35,36,42,44 In the literature, short to midterm clinical outcomes of cervical arthroplasty were not significantly impaired by HO. 34,[40][41][42] There was also heterogeneity in both location and morphology of HO formation.…”

Section: Discussionmentioning

confidence: 99%

Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

Huang

et al. 2015

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OBJECT Heterotopic ossification (HO) after cervical arthroplasty is not uncommon and may cause immobility of the disc. To prevent HO formation, study protocols of clinical trials for cervical arthroplasty undertaken by the US FDA included perioperative use of nonsteroidal antiinflammatory drugs (NSAIDs). However, there are few data supporting the use of NSAIDs to prevent HO after cervical arthroplasty. Therefore, this study aimed to evaluate the efficacy of NSAIDs in HO formation and clinical outcomes. METHODS Consecutive patients who underwent 1- or 2-level cervical arthroplasty with a minimum follow-up of 24 months were retrospectively reviewed. All patients were grouped into 1 of 2 groups, an NSAID group (those patients who had used NSAIDs postoperatively) and a non-NSAID group (those patients who had not used NSAIDs postoperatively). The formation of HO was detected and classified using CT in every patient. The incidence of HO formation, disc mobility, and clinical outcomes, including visual analog scale (VAS) scores of neck and arm pain, neck disability index (NDI) scores, and complications were compared between the two groups. Furthermore, a subgroup analysis of the patients in the NSAID group, comparing the selective cyclooxygenase (COX)-2 to nonselective COX-2 NSAID users, was also conducted for each of the above-mentioned parameters. RESULTS A total of 75 patients (mean age [± SD] 46.71 ± 9.94 years) with 107 operated levels were analyzed. The mean follow-up duration was 38.71 ± 9.55 months. There were no significant differences in age, sex, and levels of arthroplasty between the NSAID and non-NSAID groups. There was a nonsignificantly lower rate of HO formation in the NSAID group than the non-NSAID group (47.2% vs. 68.2%, respectively; p = 0.129). During follow-up, most of the arthroplasty levels remained mobile, with similar rates of immobile discs in the NSAID and non-NSAID groups (13.2% and 22.7%, respectively; p = 0.318). Furthermore, there was a nonsignificantly lower rate of HO formation in the selective COX-2 group than the nonselective COX-2 group (30.8% vs 52.5%, respectively; p = 0.213). The clinical outcomes, including VAS neck, VAS arm, and NDI scores at 24 months postoperatively, were all similar in the NSAID and non-NSAID groups, as well as the selective and nonselective COX-2 groups (all p > 0.05). CONCLUSIONS In this study there was a trend toward less HO formation and fewer immobile discs in patients who used postoperative NSAIDs after cervical arthroplasty than those who did not, but this trend did not reach statistical significance. Patients who used selective COX-2 NSAIDs had nonsignificantly less HO than those who used nonselective COX-2 NSAIDs. The clinical outcomes were not affected by the use of NSAIDs or the kinds of NSAIDs used (selective vs nonselective COX-2). However, the study was limited by the number of patients included, and the efficacy of NSAIDs in the prevention of HO after cervical arthroplasty may need further investigation to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

Huang

et al. 2015

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“…Many studies have reported that CDA is safe and effective with equivalent or superior clinical outcome to anterior cervical decompression and fusion, 11,22 but whether CDA can reduce ASD remains controversial. Kim et al 17 performed a systematic review and found that CDA showed lower rates of adjacent-level ossification development compared with ACDF at both short-and long-term follow-up. Garrido et al 10 reported that CAD with Bryan cervical disc prosthesis (Medtronic Sofamor Danek) was associated with a lower incidence of adjacent-level ossification compared with arthrodesis with plate fixation at 2-and 4-year follow-up evaluations.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis

Kan¹,

Kang²,

Gao³

et al. 2014

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Object To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 “skip” disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated. Methods Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated. Results The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0.038). Conclusions Both of the hybrid procedures (anterior cervical corpectomy and fusion [ACCF] + anterior cervical discectomy and fusion, and ACCF + cervical disc arthroplasty [CDA]) yielded favorable clinical and radiological outcomes in the treatment of noncontiguous 3-level cervical spondylosis. Moreover, the ACCF + CDA procedure may have the ability to decrease the likelihood of ASD in appropriate patients.

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“…For PS, the entry point was previously described to be on the anterior edge of the C2 end plate and a few millimeters lateral to the midline, on the side ipsilateral to the C1-C2 joint to be fixated [1][2][3]. We moved the entry point 5 mm cranially to decrease the risk of adjacent level ossification [23,24] at C2-C3. In addition, we moved the entry point to the side contralateral to the C1-C2 joint to be fixated, to maintain a transcorporal pathway for the screw and to minimize the possibility of the screw cutting out of the anterior cortex of the C2 promontory.…”

Section: Screw Entry Pointsmentioning

confidence: 99%

“…1, Top), to provide an allowable distance between the screw head and the C2-C3 intervertebral disc to prevent adjacent level ossification development [23,24]. For facet screws (CF, MF, and LF), the area below the anterior prominent ridge of the axis was divided into medial and lateral parts by a vertical line bisecting the anterior margin of the C1-C2 facet joint.…”

Section: Screw Entry Points and Trajectoriesmentioning

confidence: 99%

Fluoroscopically guided anterior atlantoaxial transarticular screws: a feasibility and trajectory study using CT-based simulation software

et al. 2013

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BACKGROUND CONTEXT: Anterior transarticular screw (ATAS) fixation has been suggested as a viable alternative to posterior stabilization. However, we are not aware of previous reports attempting to establish the usefulness of specific fluoroscopic landmark-guided trajectories in the use of ATAS, and we could find no reference to it in a computerized search using MEDLINE. PURPOSE: To determine the anatomic feasibility of ATAS placement using defined fluoroscopic landmarks to guide screw trajectory. STUDY DESIGN: Evaluation using three-dimensional screw insertion simulation software and 1.0-mm-interval computed tomographic scans. PATIENT SAMPLE: Computed tomographic scans of 100 patients including 50 men and 50 women. OUTCOME MEASURES: Incidence of violation of the vertebral artery groove of C1 and C2, the spinal canal, and the atlanto-occipital joint and screw lengths and lengths of C1 and C2 purchase. METHODS: Four screw trajectories were determined: promontory screw (PS), single central facet (CF) screw, and medial (MF) and lateral (LF) double facet screws. Placement of a 4.0-mm screw was simulated using defined fluoroscopic landmarks for each trajectory. The previously mentioned outcome measures were evaluated and compared for the four trajectories. This study was not supported by any financial sources, and there is no topic-specific potential conflict of interest with this study. The disclosure key can be found on the CONCLUSIONS:Our results suggest that it may be possible to place ATASs without violating the vertebral artery groove, spinal canal, or the atlanto-occipital joint by using the described entry points, trajectories, and fluoroscopic landmarks. Ó

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The Risk of Adjacent-Level Ossification Development After Surgery in the Cervical Spine

Abstract: We recommend that the surgeon make every effort to keep the plate as far away from the adjacent disc as possible. Strength of Statement: Strong.

Cited by 54 publications

References 10 publications

Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis

Fluoroscopically guided anterior atlantoaxial transarticular screws: a feasibility and trajectory study using CT-based simulation software

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