Quantitative analysis of the correlation between preoperative cervical degeneration and postoperative heterotopic ossification after cervical disc replacement: minimum 10-year follow-up data

View More View Less
  • 1 Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and
  • 2 Texas Back Institute, Plano, Texas
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The authors aimed to identify factors that may be useful for quantifying the amount of degenerative change in preoperative patients to identify ideal candidates for cervical disc replacement (CDR) in patients with a minimum of 10 years of follow-up data.

METHODS

During the period from December 2003 to August 2008, 54 patients underwent CDR with a Bryan cervical disc prosthesis performed by the same group of surgeons, and all of the patients in this group with at least 10 years of follow-up data were enrolled in this retrospective analysis of cases. Postoperative bone formation was graded in radiographic images by using the McAfee classification for heterotopic ossification. Preoperative degeneration was evaluated in radiographs based on a quantitative scoring system. After univariate analysis, the authors performed multifactor logistic regression analysis to identify significant factors. To determine the cutoff points for the significant factors, a receiver operating characteristic (ROC) curve analysis was conducted.

RESULTS

Study patients had a mean age of 43.6 years and an average follow-up period of 120.3 months. The patients as a group had a 68.2% overall incidence of bone formation. Based on univariate analysis results, data for patient sex, disc height, and the presence of anterior osteophytes and endplate sclerosis were included in the multivariate analysis. According to the analysis results, the identified independent risk factors for postoperative bone formation included disc height, the presence of anterior osteophytes, and endplate sclerosis, and according to a quantitative scoring system for degeneration of the cervical spine based on these variables, the ROC curve indicated that the optimal cutoff scores for these risk factors were 0.5, 1.5, and 1.5, respectively.

CONCLUSIONS

Among the patients who were followed up for at least 10 years after CDR, the incidence of postoperative bone formation was relatively high. The study results indicate that the degree of degeneration in the target level before surgery has a positive correlation with the incidence of postoperative ossification. Rigorous indication criteria for postoperative ossification should be applied in patients for whom CDR may be a treatment option.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; AUC = area under the curve; CDR = cervical disc replacement; HO = heterotopic ossification; OALL = ossification of the anterior longitudinal ligament; ROC = receiver operating characteristic; ROM = range of motion.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Yu Sun: Peking University Third Hospital, Haidian District, Beijing, China. sunyuor@outlook.com.

INCLUDE WHEN CITING Published online July 17, 2020; DOI: 10.3171/2020.4.SPINE191303.

F. Zhou, S. Li, and Y. Zhao contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Dejaegher J, Walraevens J, van Loon J, 10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis. Eur Spine J. 2017;26(4):11911198.

    • Search Google Scholar
    • Export Citation
  • 2

    Chen J, Wang X, Bai W, Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis. Eur Spine J. 2012;21(4):674680.

    • Search Google Scholar
    • Export Citation
  • 3

    Kim KS, Heo DH. Do postoperative biomechanical changes induce heterotopic ossification after cervical arthroplasty?: a 5-year follow-up study. Clin Spine Surg. 2016;29(6):E309E313.

    • Search Google Scholar
    • Export Citation
  • 4

    Zhou F, Ju KL, Zhao Y, Progressive bone formation after cervical disc replacement: minimum of 5-year follow-up. Spine (Phila Pa 1976). 2018;43(3):E163E170.

    • Search Google Scholar
    • Export Citation
  • 5

    Walraevens J, Liu B, Meersschaert J, Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints. Eur Spine J. 2009;18(3):358369. Published correction in Eur Spine J. 2009;18(3):370.

    • Search Google Scholar
    • Export Citation
  • 6

    White AA III, Panjabi MM. The basic kinematics of the human spine. A review of past and current knowledge. Spine (Phila Pa 1976). 1978;3(1):1220.

    • Search Google Scholar
    • Export Citation
  • 7

    Hosmer DW, Lemeshow S. Assessing the fit of the model. In: Hosmer DW, Lemeshow S, eds. Applied Logistic Regression. 2nd ed. John Wiley & Sons; 2000:143202.

    • Search Google Scholar
    • Export Citation
  • 8

    Park CK, Ryu KS. Are controversial issues in cervical total disc replacement resolved or unresolved?: a review of literature and recent updates. Asian Spine J. 2018;12(1):178192.

    • Search Google Scholar
    • Export Citation
  • 9

    Timothy J, Petralia V, Wilson JR. Use of an ultrasonic bone curet for the extraction of a cervical artificial disc: a novel application: a case report. JBJS Case Connect. 2018;8(1):e5.

    • Search Google Scholar
    • Export Citation
  • 10

    Chung SB, Muradov JM, Lee SH, Uncovertebral hypertrophy is a significant risk factor for the occurrence of heterotopic ossification after cervical disc replacement: survivorship analysis of Bryan disc for single-level cervical arthroplasty. Acta Neurochir (Wien). 2012;154(6):10171022.

    • Search Google Scholar
    • Export Citation
  • 11

    Lazaro BC, Yucesoy K, Yuksel KZ, Effect of arthroplasty design on cervical spine kinematics: analysis of the Bryan Disc, ProDisc-C, and Synergy disc. Neurosurg Focus. 2010;28(6):E6.

    • Search Google Scholar
    • Export Citation
  • 12

    Pandey PK, Pawar I, Gupta J, Verma RR. Comparison of outcomes of single-level anterior cervical discectomy with fusion and single-level artificial cervical disc replacement for single-level cervical degenerative disc disease. Spine (Phila Pa 1976). 2017;42(1):E41E49.

    • Search Google Scholar
    • Export Citation
  • 13

    Rožanković M, Marasanov SM, Vukić M. Cervical disk replacement with discover versus fusion in a single-level cervical disk disease: a prospective single-center randomized trial with a minimum 2-year follow-up. Clin Spine Surg. 2017;30(5):E515E522.

    • Search Google Scholar
    • Export Citation
  • 14

    Tian W, Yan K, Han X, Comparison of the clinical and radiographic results between cervical artificial disk replacement and anterior cervical fusion: a 6-year prospective nonrandomized comparative study. Clin Spine Surg. 2017;30(5):E578E586.

    • Search Google Scholar
    • Export Citation
  • 15

    Yi S, Lee DY, Ahn PG, Radiologically documented adjacent-segment degeneration after cervical arthroplasty: characteristics and review of cases. Surg Neurol. 2009;72(4):325329.

    • Search Google Scholar
    • Export Citation
  • 16

    Mehren C, Heider F, Siepe CJ, Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement. Eur Spine J. 2017;26(9):24412449.

    • Search Google Scholar
    • Export Citation
  • 17

    Yi S, Shin DA, Kim KN, The predisposing factors for the heterotopic ossification after cervical artificial disc replacement. Spine J. 2013;13(9):10481054.

    • Search Google Scholar
    • Export Citation
  • 18

    Zeng J, Liu H, Chen H, Comparison of heterotopic ossification after fixed- and mobile-core cervical disc arthroplasty. World Neurosurg. 2018;120:e1319e1324.

    • Search Google Scholar
    • Export Citation
  • 19

    Zeng J, Liu H, Chen H, Effect of prosthesis width and depth on heterotopic ossification after cervical disc arthroplasty. Spine (Phila Pa 1976). 2019;44(9):624628.

    • Search Google Scholar
    • Export Citation
  • 20

    Zeng J, Liu H, Rong X, Clinical and radiographic outcomes of cervical disc arthroplasty with Prestige-LP Disc: a minimum 6-year follow-up study. BMC Musculoskelet Disord. 2018;19(1):285.

    • Search Google Scholar
    • Export Citation
  • 21

    Wu JC, Huang WC, Tu TH, Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up. J Neurosurg Spine. 2012;16(2):163171.

    • Search Google Scholar
    • Export Citation
  • 22

    Qi M, Chen H, Cao P, Incidence and risk factors analysis of heterotopic ossification after cervical disc replacement. Chin Med J (Engl). 2014;127(22):38713875.

    • Search Google Scholar
    • Export Citation
  • 23

    Bertagnoli R, Kumar S. Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J. 2002;11(suppl 2):S131S136.

    • Search Google Scholar
    • Export Citation
  • 24

    Auerbach JD, Jones KJ, Fras CI, The prevalence of indications and contraindications to cervical total disc replacement. Spine J. 2008;8(5):711716.

    • Search Google Scholar
    • Export Citation
  • 25

    Jin YJ, Park SB, Kim MJ, An analysis of heterotopic ossification in cervical disc arthroplasty: a novel morphologic classification of an ossified mass. Spine J. 2013;13(4):408420.

    • Search Google Scholar
    • Export Citation
  • 26

    Sundseth J, Jacobsen EA, Kolstad F, Heterotopic ossification and clinical outcome in nonconstrained cervical arthroplasty 2 years after surgery: the Norwegian Cervical Arthroplasty Trial (NORCAT). Eur Spine J. 2016;25(7):22712278.

    • Search Google Scholar
    • Export Citation
  • 27

    Zhao Y, Zhang Y, Sun Y, Application of cervical arthroplasty with Bryan cervical disc: 10-year follow-up results in China. Spine (Phila Pa 1976). 2016;41(2):111115.

    • Search Google Scholar
    • Export Citation
  • 28

    Zhou HH, Qu Y, Dong RP, Does heterotopic ossification affect the outcomes of cervical total disc replacement? A meta-analysis. Spine (Phila Pa 1976). 2015;40(6):E332E340.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 97 97 80
Full Text Views 37 37 32
PDF Downloads 35 35 30
EPUB Downloads 0 0 0