Association between anterior bone loss and anterior heterotopic ossification in hybrid surgery
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RESEARCH ARTICLE
Open Access
Association between anterior bone loss and anterior heterotopic ossification in hybrid surgery Junbo He†, Hao Liu†, Tingkui Wu, Chen Ding, Kangkang Huang, Ying Hong and Beiyu Wang*
Abstract Background: Hybrid surgery (HS) has become an alternative procedure for the treatment of multilevel cervical degenerative disc disease with satisfactory outcomes. However, some adverse outcomes have recently emerged, such as heterotopic ossification (HO) and anterior bone loss (ABL). Furthermore, HO was found mostly located in the posterior and lateral of the cervical intervertebral disc space. The mechanism of anterior heterotopic ossification (AHO) formation may be different, and its relationship with ABL was uncertain. Methods: Radiographical and clinical outcomes of ninety-seven patients who had undergone contiguous twolevel HS between December 2010 and December 2017 and with a minimum of 2-year follow-up were analyzed. Postoperative radiographs were evaluated and compared to the initial postoperative films to determine the incidence of ABL and AHO. Results: The overall incidence rate of ABL was 44.3% (43/97). It was identified in 70.6% of AHO cases (33.3% mild, 41.7% moderate, 25.0% severe) and 38.8% of non-AHO cases (38.7% mild, 45.2% moderate, 16.1% severe). A significant association between ABL and AHO occurrence was found (P = 0.016). There was no significant difference in prosthesis–endplate depth ratio or disc space angle change between the AHO group and the non-AHO group (P > 0.05). Compared with data preoperatively, clinical outcome scores significantly improved after surgery in both the AHO and non-AHO groups, with no significant differences between the two groups (P > 0.05). Conclusion: ABL was common in HS, and it related to AHO. The formation of AHO could be an integral part of postoperative bone remodeling, as well as ABL. Keywords: Anterior bone loss, Anterior heterotopic ossification, Hybrid surgery
Introduction Cervical degenerative disc disease (CDDD) is a common, age-related, and progressive disorder that can present with mechanical neck pain, radiculopathy, myelopathy, or a combination of these symptoms. Surgery is generally indicated to treat these patients when conservative * Correspondence: [email protected] † Junbo He and Hao Liu contributed equally to this work and should be considered co-first authors Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
treatments fail and has yielded satisfactory clinical outcomes via several approaches [1]. Compared with traditional anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA) has been demonstrated to preserve the range of motion (ROM) at the operated level and thereby decrease the incidence of adjacent segment pathology [2–4]. However, the surgical indications of CDA are relatively narrow and not acceptable for all diseased levels. Meanwhile, multilevel CDA might add difficulty to the technique, increase the possibility of disc
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