Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up

Clinical article

Restricted access

Object

Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty.

Methods

Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months.

Results

Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in both groups remained mobile (100% and 95.8%, p = 0.408). The clinical outcomes were not significantly different between the groups at all postoperative time points of evaluation, and clinical improvements were also similar.

Conclusions

Clinical outcomes of single-level cervical arthroplasty for soft-disc herniation and spondylosis were similar 3 years after surgery. There was a significantly higher rate of HO formation in patients with spondylosis than in those with a soft-disc herniation. The mobility of the artificial disc is maintained, but the long-term effects of HO and its higher frequency in spondylotic cases warrant further investigation.

Abbreviations used in this paper: ACDF = anterior cervical discectomy and fusion; DDD = degenerative disc disease; HO = heterotopic ossification; IDE = investigational device exemption; NDI = Neck Disability Index; ROM = range of motion; VAS = visual analog scale.

Article Information

* Drs. J. C. Wu and Huang contributed equally to this work.

Address correspondence to: Chin-Chu Ko, M.D., Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 509, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan. email: hansamu0627@gmail.com.

Please include this information when citing this paper: published online December 2, 2011; DOI: 10.3171/2011.10.SPINE11497.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Studies obtained in a patient with a soft-disc herniation group who underwent cervical arthroplasty and did not develop HO on follow-up. A: Preoperative lateral radiograph. Arrow indicates the C5–6 index level. B and C: Postoperative dynamic flexion and extension radiographs showing preserved mobility at the index level. D and E: Postoperative sagittal and axial CT scans demonstrating no HO formation.

  • View in gallery

    Studies obtained in a patient with spondylosis who underwent cervical arthroplasty and developed HO on follow-up. A: Preoperative lateral radiograph. Arrow indicates the C5–6 index level. B and C: Postoperative dynamic flexion and extension radiographs demonstrating preserved mobility at the index level. D and E: Postoperative sagittal and axial CT scans revealing Grade 2 HO formation (arrowhead).

  • View in gallery

    Studies obtained in a patient with spondylosis who underwent cervical arthroplasty, had HO, and lost mobility at the index level on follow-up. A: Preoperative lateral radiograph showing the C3–4 index level (arrow). B and C: Postoperative dynamic flexion and extension radiographs demonstrating a limited ROM at the index level (effective ROM 2°). D and E: Postoperative sagittal and axial CT scans revealing Grade 3 HO formation (arrowheads).

  • View in gallery

    Graphs showing VAS scores for neck pain. Comparisons of patients with soft-disc herniation and spondylosis (overall 40 individuals) (A), those with and without HO in the soft-disc herniation group (16 individuals) (B), and those with and without HO in the spondylosis group (24 individuals) (C). There was no significant difference between the herniation and spondylosis groups at any time points, but significant differences existed at all postoperative time points compared with preoperative points.

  • View in gallery

    Graphs showing VAS scores for arm pain. Comparisons of patients with soft-disc herniation and spondylosis (overall 40 individuals) (A), those with and without HO in the soft-disc herniation group (16 individuals) (B), and those with and without HO in the spondylosis group (24 individuals) (C). There was no significant difference between the herniation and spondylosis groups at any time points, but significant differences existed at all postoperative time points compared with preoperative points.

  • View in gallery

    Graphs showing NDI scores. Comparisons of patients with soft-disc herniation and spondylosis (overall 40 individuals) (A), those with and without HO in the soft-disc herniation group (16 individuals) (B), and those with and without HO in the spondylosis group (24 individuals) (C). There was no significant difference between the herniation and spondylosis groups at any time points, but significant differences existed at all postoperative time points compared with preoperative points.

References

1

Beaurain JBernard PDufour TFuentes JMHovorka IHuppert J: Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J 18:8418502009

2

Boakye MMummaneni PVGarrett MRodts GHaid R: Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein. J Neurosurg Spine 2:5215252005

3

Burkus JKHaid RWTraynelis VCMummaneni PV: Longterm clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. Clinical article. J Neurosurg Spine 13:3083182010

4

Coric DCassis JCarew JDBoltes MO: Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. Clinical article. J Neurosurg Spine 13:7157212010

5

Coric DFinger FBoltes P: Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31352006

6

Delamarter RBMurrey DJanssen MEGoldstein JAZigler JTay BKB: Results at 24 months from the prospective, randomized, multicenter Investigational Device Exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up and continued access patients. SAS J 4:1221282010

7

Fessler RGSasso RAnderson PPapadopoulos SHeller J: BRYAN Cervical Disc Replacement: four-year follow-up results from the United States Prospective Randomized Clinical Trial: 921. Neurosurgery 65:4074082009

8

Fraser JFHärtl R: Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6:2983032007

9

Heidecke VBurkert WBrucke MRainov NG: Intervertebral disc replacement for cervical degenerative disease—clinical results and functional outcome at two years in patients implanted with the Bryan cervical disc prosthesis. Acta Neurochir (Wien) 150:4534592008

10

Heller JGSasso RCPapadopoulos SMAnderson PAFessler RGHacker RJ: Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34:1011072009

11

Lestini WFWiesel SW: The pathogenesis of cervical spondylosis. Clin Orthop Relat Res 239:69931989

12

Leung CCasey ATGoffin JKehr PLiebig KLind B: Clinical significance of heterotopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery 57:7597632005

13

Matz PGAnderson PAHolly LTGroff MWHeary RFKaiser MG: The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 11:1041112009

14

McAfee PCCunningham BWDevine JWilliams EYu-Yahiro J: Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech 16:3843892003

15

Mehren CSuchomel PGrochulla FBarsa PSourkova PHradil J: Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976) 31:280228062006

16

Mizuno JNakagawa H: Anterior decompression for cervical spondylosis associated with an early form of cervical ossification of the posterior longitudinal ligament. Neurosurg Focus 12:1E122002

17

Mizuno JNakagawa H: Outcome analysis of anterior decompressive surgery and fusion for cervical ossification of the posterior longitudinal ligament: report of 107 cases and review of the literature. Neurosurg Focus 10:4E62001

18

Mummaneni PVBurkus JKHaid RWTraynelis VCZdeblick TA: Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:1982092007

19

Mummaneni PVHaid RW: The future in the care of the cervical spine: interbody fusion and arthroplasty. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:1551592004

20

Mummaneni PVRobinson JCHaid RW Jr: Cervical arthroplasty with the PRESTIGE LP cervical disc. Neurosurgery 60:4 Suppl 23103152007

21

Murrey DJanssen MDelamarter RGoldstein JZigler JTay B: Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:2752862009

22

Naderi SSonntag VKH: The current role of CT myelography and myelography in neurosurgical practice. Crit Rev Neurosurg 7:24281997

23

Sasso RCSmucker JDHacker RJHeller JG: Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine (Phila Pa 1976) 32:293329422007

24

Sasso RCSmucker JDHacker RJHeller JG: Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech 20:4814912007

25

Steinmetz MPPatel RTraynelis VResnick DKAnderson PA: Cervical disc arthroplasty compared with fusion in a workers' compensation population. Neurosurgery 63:7417472008

26

Suchomel PJurák LBenes V IIIBrabec RBradác OElgawhary S: Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J 19:3073152010

27

Traynelis VC: Cervical arthroplasty. Clin Neurosurg 53:2032072006

28

Tu THWu JCHuang WCGuo WYWu CLShih YH: Heterotopic ossification after cervical total disc replacement: determination by CT and effects on clinical outcomes. Clinical article. J Neurosurg Spine 14:4574652011

29

Tumialán LMPan JRodts GEMummaneni PV: The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients. J Neurosurg Spine 8:5295352008

30

Wu JCHuang WCMummaneni PV: Prestige cervical arthroplasty. Tech Orthop 25:1081132010

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 32 32 9
Full Text Views 64 64 23
PDF Downloads 87 87 10
EPUB Downloads 0 0 0

PubMed

Google Scholar