Abstract
Heterotopic ossification is a phenomenon in cervical arthroplasty. Previous reports have mainly focused on various semiconstrained devices and only a few publications have focused on ossification around devices that are nonconstrained. The purpose of this study was to assess the occurrence of heterotopic ossification around a nonconstrained cervical device and how it affects clinical outcome 2years after surgery. Thirty-seven patients were included from a larger cohort of a randomized controlled trial (NORCAT) which compared single-level cervical arthroplasty with fusion. The occurrence of heterotopic ossification was assessed with a CT scan and two neuroradiologists determined its degree. For grading, we used the Mehren/Suchomel classification system (grade 0-4). The patients were divided by level of ossification, low grade (0-2) or high grade (3-4), and clinical outcomes were compared. Self-rated disability for neck and arm pain (Neck Disability Index), health-related quality of life (the Short Form-36 and EuroQol-5D), and pain (the Numeric Rating Scale 11) were used as clinical outcome measures. Heterotopic ossification was encountered in all patients 2years after surgery. Complete fusion (grade 4) was found in 16% of participants, and high-grade ossification (grade 3-4) occurred in 62%. The remaining patients were classified as having low-grade ossification (grade 2). There were no differences in the clinical outcomes of patients with low- and high-grade ossification. High-grade heterotopic ossification and spontaneous fusion 2years after surgery were seen in a significant number of patients. However, the degree of ossification did not influence the clinical outcome.
Highlights
The gold standard for surgical treatment of cervical radiculopathy has been cervical discectomy and fusion (ACDF)
Thirty-seven patients were included from a larger cohort of a randomized controlled trial (NORCAT) which compared single-level cervical arthroplasty with fusion
The objective of this study was to investigate the occurrence of heterotopic ossification 2 years after arthroplasty surgery, and to assess if the degree of ossification had an impact on the clinical outcome
Summary
The gold standard for surgical treatment of cervical radiculopathy has been cervical discectomy and fusion (ACDF). The introduction of anterior cervical discectomy and arthroplasty (ACDA), which aims to preserve motion at the operated level, has gained growing interest among spinal surgeons. This interest is accompanied by concern with respect to heterotopic ossification (HO), a well-known phenomenon in arthroplasty of the hip and knee [7, 8]. The present study was realized under the framework of the Norwegian Cervical Arthroplasty Trial (NORCAT) to assess to what degree preservation of motion was maintained 2 years after surgery, and to compare our results with previous reports.
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