Heterotopic ossification and radiographic adjacent-segment disease after cervical disc arthroplasty

2019 ◽  
Vol 31 (5) ◽  
pp. 660-669 ◽  
Author(s):  
Michael M. H. Yang ◽  
Won Hyung A. Ryu ◽  
Steven Casha ◽  
Stephan DuPlessis ◽  
W. Bradley Jacobs ◽  
...  
Keyword(s):  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Low Grade ◽  
High Grade ◽  
Artificial Disc ◽  
Disc Arthroplasty ◽  
The Mean ◽  
Index Level

OBJECTIVECervical disc arthroplasty (CDA) is an accepted motion-sparing technique associated with favorable patient outcomes. However, heterotopic ossification (HO) and adjacent-segment degeneration are poorly understood adverse events that can be observed after CDA. The purpose of this study was to retrospectively examine 1) the effect of the residual exposed endplate (REE) on HO, and 2) identify risk factors predicting radiographic adjacent-segment disease (rASD) in a consecutive cohort of CDA patients.METHODSA retrospective cohort study was performed on consecutive adult patients (≥ 18 years) who underwent 1- or 2-level CDA at the University of Calgary between 2002 and 2015 with > 1-year follow-up. REE was calculated by subtracting the anteroposterior (AP) diameter of the arthroplasty device from the native AP endplate diameter measured on lateral radiographs. HO was graded using the McAfee classification (low grade, 0–2; high grade, 3 and 4). Change in AP endplate diameter over time was measured at the index and adjacent levels to indicate progressive rASD.RESULTSForty-five patients (58 levels) underwent CDA during the study period. The mean age was 46 years (SD 10 years). Twenty-six patients (58%) were male. The median follow-up was 29 months (IQR 42 months). Thirty-three patients (73%) underwent 1-level CDA. High-grade HO developed at 19 levels (33%). The mean REE was 2.4 mm in the high-grade HO group and 1.6 mm in the low-grade HO group (p = 0.02). On multivariable analysis, patients with REE > 2 mm had a 4.5-times-higher odds of developing high-grade HO (p = 0.02) than patients with REE ≤ 2 mm. No significant relationship was observed between the type of artificial disc and the development of high-grade HO (p = 0.1). RASD was more likely to develop in the lower cervical spine (p = 0.001) and increased with time (p < 0.001). The presence of an artificial disc was highly protective against degenerative changes at the index level of operation (p < 0.001) but did not influence degeneration in the adjacent segments.CONCLUSIONSIn patients undergoing CDA, high-grade HO was predicted by REE. Therefore, maximizing the implant-endplate interface may help to reduce high-grade HO and preserve motion. RASD increases in an obligatory manner following CDA and is highly linked to specific levels (e.g., C6–7) rather than the presence or absence of an adjacent arthroplasty device. The presence of an artificial disc is, however, protective against further degenerative change at the index level of operation.

Myelopathy after cervical disc arthroplasty due to progression of spondylosis at the index level: case report

2018 ◽  
Vol 28 (5) ◽  
pp. 467-471
Author(s):  
Anita Bhansali ◽  
Michael Musacchio ◽  
Noam Stadlan
Keyword(s):  
Case Report ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Artificial Disc ◽  
Rare Occurrence ◽  
Disc Disease ◽  
Disc Arthroplasty ◽  
Low Incidence ◽  
Index Level ◽  
Better Than

Cervical disc arthroplasty (CDA) has emerged as a popular alternative to anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disc disease. CDA has been well studied, with efficacy reported to be equivalent to or better than that seen with ACDF, and it is associated with a consistently low incidence of adverse events. The development or progression of myelopathy after CDA is a particularly rare occurrence. In this report, the authors describe the first known case of recurrence of myelopathy at the index level of surgery after CDA implantation due the continuation of the spondylitic process after placement of the artificial disc.

scholarly journals Stepwise illustration of teeth-fixation semi-constrained cervical disc arthroplasty

2017 ◽  
Vol 42 (videosuppl1) ◽  
pp. V4 ◽  
Author(s):  
Chih-Chang Chang ◽  
Jau-Ching Wu ◽  
Peng-Yuan Chang ◽  
Mei-Yin Yeh ◽  
Yi-Hsuan Kuo ◽  
...  
Keyword(s):  
Large Scale ◽  
Primary Stability ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Artificial Disc ◽  
Joint Function ◽  
Disc Arthroplasty ◽  
The Us ◽  
Randomized Control

There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market.The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4–5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level.The video can be found here: https://youtu.be/4DSES1xgvQU.

scholarly journals Biomechanical Study of Cervical Disc Arthroplasty Devices Using Finite Element Modeling

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Narayan Yoganandan ◽  
Yuvaraj Purushothaman ◽  
Hoon Choi ◽  
Jamie Baisden ◽  
Deepak Rajasekaran ◽  
...  
Keyword(s):  
Finite Element ◽  
Intradiscal Pressure ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Lateral Bending ◽  
Disc Arthroplasty ◽  
Bryan Disc ◽  
Flexion Extension ◽  
Index Level

Abstract Many artificial discs for have been introduced to overcome the disadvantages of conventional anterior discectomy and fusion. The purpose of this study was to evaluate the performance of different U.S. Food and Drug Administration (FDA)-approved cervical disc arthroplasty (CDA) on the range of motion (ROM), intradiscal pressure, and facet force variables under physiological loading. A validated three-dimensional finite element model of the human intact cervical spine (C2-T1) was used. The intact spine was modified to simulate CDAs at C5-C6. Hybrid loading with a follower load of 75 N and moments under flexion, extension, and lateral bending of 2 N·m each were applied to intact and CDA spines. From this work, it was found that at the index level, all CDAs except the Bryan disc increased ROM, and at the adjacent levels, motion decreased in all modes. The largest increase occurred under the lateral bending mode. The Bryan disc had compensatory motion increases at the adjacent levels. Intradiscal pressure reduced at the adjacent levels with Mobi-C and Secure-C. Facet force increased at the index level in all CDAs, with the highest force with the Mobi-C. The force generally decreased at the adjacent levels, except for the Bryan disc and Prestige LP in lateral bending. This study demonstrates the influence of different CDA designs on the anterior and posterior loading patterns at the index and adjacent levels with head supported mass type loadings. The study validates key clinical observations: CDA procedure is contraindicated in cases of facet arthroplasty and may be protective against adjacent segment degeneration.

scholarly journals Does Positioning of Cervical Disc Arthroplasty Implant Affect Postoperative Outcome

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yahya Othman ◽  
Todd Albert ◽  
Russell Huang ◽  
Philip York ◽  
Avani Vaishnav ◽  
...  
Keyword(s):  
Short Form ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Arthroplasty ◽  
Outcomes Measures ◽  
Implant Positioning ◽  
Postoperative Score ◽  
Patient Reported

Abstract INTRODUCTION Cervical disc arthroplasty (CDA) is a surgical option for patients with cervical radiculopathy symptoms that have failed conservative management. CDA has a lower incidence of adjacent segment disease as well as reoperation rates. Proper surgical technique is critical for success of CDA surgery. The aim of this study was to investigate whether implant positioning has an impact on the outcomes of CDA surgery. METHODS Following local Institutional Review Board (IRB) approval, a retrospective study was conducted on consecutive patients undergoing CDA with the Mobi-C implant (Zimmer Biomet, IN) between January 2016 and December 2018. Immediately postoperative lateral and AP radiographs were assessed by 3 spine surgeons for implant positioning. Our scoring criteria included rotational, sagittal, and coronal placement as well as size matching. AP and lateral radiographs were scored independently and the overall postoperative score was calculated as the sum of the 2 scores. The overall postoperative score was correlated with 5 patient reported outcomes measures (PROMS); Visual Analogue Scale (VAS) arm, VAS neck, Neck Disability Index (NDI), and Short Form 12 Physical health (SF12-P) and mental health (SF12-M). RESULTS Radiographs of 85 patients, and 110 levels, that underwent CDA were assessed. Of those, 41 patients were excluded from the PROMS analysis due to inadequate follow-up. Inter-rater reliability for radiographic assessment was good to excellent. Mean follow-up was 8 mo and ranged from 6 to 24 mo. The overall implant positioning scores showed strong correlation with NDI and SF12-P outcomes measures at latest follow up (P = .007, P = .028, respectively). CONCLUSION Proper implant sizing and implant rotational and translational positioning have a significant impact on functional and disability outcomes of patients undergoing CDA surgery. Further research is warranted to investigate other parameters that affect the outcomes of CDA surgery.

High prevalence of heterotopic ossification after cervical disc arthroplasty: outcome and intraoperative findings following explantation of 22 cervical disc prostheses

2012 ◽  
Vol 17 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Christopher Brenke ◽  
Johann Scharf ◽  
Kirsten Schmieder ◽  
Martin Barth
Keyword(s):  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Analog Scale ◽  
Osteophyte Formation ◽  
High Prevalence ◽  
The Mean ◽  
Neck Disability

Object Cervical disc arthroplasty (CDA) has been increasingly used for the treatment of cervical disc herniations. However, the impact of CDA on adjacent-segment degeneration and the degree of heterotopic ossification (HO) of the treated segment remain a subject of controversy. Due to a product failure of the Galileo-type disc prosthesis, 22 of these devices were explanted. The radiological and clinical course in each case was investigated in detail with an emphasis on the incidence of HO and facet joint degeneration 18 months following the operation. Intraoperative findings regarding ossification and implant fixation were documented. Thus, the authors were able to describe the true rate of adjacent-segment degeneration and HO following CDA and the clinical relevance thereof. Methods In all 22 patients, functional radiographic imaging was performed prior to surgery, 3 and 12 months after surgery, and prior to disc prosthesis explantation. At all time points, the range of motion (ROM) in the operated and adjacent segments was determined. A motion index was calculated using the preoperative and all postoperative ROMs (preoperative ROM/postoperative ROM). Computed tomography was used preoperatively to measure the height of the index segment, extent of HO, and the degree of the progression of facet arthrosis, and was used postoperatively prior to prosthesis explantation. Patients completed clinical questionnaires that included a visual analog scale and the Neck Disability Index. Results The motion index of the index segment declined gradually from 1.4 at 3 months postoperative to 1.2 prior to explantation, while the motion index of the adjacent upper segment increased from 0.9 to 1.3. The mean ROM of the index segment was 10.4° ± 6.7°, and fusion was observed in 2 (9%) of the 22 patients. Prosthesis migration was present in 3 patients (13.6%). Severe HO (Grades 3 and 4) was present in 17.4%. Computed tomography showed a significant increase of segmental height of the index segment (1.6 ± 1.1 mm, p = 0.035), and a significant increase of left-sided lateral osteophytes (1.7 ± 2.1 mm, p = 0.009). The incidence of severe osteophyte formation (> 2 mm) occurred in 40%. Intraoperative findings reflected the results from CT, with primary lateral proliferation of osteophytes found in approximately 25% of patients. The mean visual analog scale scores were 3.8 ± 2.7 (neck) and 2.4 ± 2.5 (arms), and the mean Neck Disability Index score was 30 ± 22. No correlation was found between radiological and clinical parameters. Conclusions In this study, a higher incidence of HO after CDA could be demonstrated using CT, compared with studies using fluoroscopy only. However, patient selection and/or the operative technique might have contributed to the high prevalence of osteophyte formation. Thus, the exact indication for CDA has to be reconsidered. Because implant migration was detected, using fixation in the present CDA model appears suboptimal.

Clinical and radiological outcomes of cervical disc arthroplasty: ten year follow-up study

2018 ◽  
Vol 42 (10) ◽  
pp. 2389-2396 ◽  
Author(s):  
Qingpeng Song ◽  
Da He ◽  
Xiao Han ◽  
Ning Zhang ◽  
Jinchao Wang ◽  
...  
Keyword(s):  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty ◽  
Follow Up Study
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