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Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic
Nicholas Hui1,2, Kevin Phan1,2, Hoi Man Kevin Cheng2
1NeuroSpine Surgery Research Group, Sydney, Australia.
Insights
Heterotopic ossification (HO) after cervical total disc replacement (CTDR) is linked to adjacent segment degeneration (ASDegeneration) and dysphagia. This systematic review quantifies complication rates and confirms HO
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Cervical total disc replacement (CTDR) is a common procedure, but complication rates are not well-quantified.
- Heterotopic ossification (HO) is a known complication of CTDR, and is suspected to cause adjacent segment degeneration (ASDegeneration).
- The association between HO and ASDegeneration has not been definitively established through meta-analysis.
Purpose of the Study:
- To systematically review and meta-analyze complication rates following CTDR.
- To investigate the pooled prevalence of complications, specifically focusing on HO.
- To examine the association between HO and other complications, including ASDegeneration.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Embase, MEDLINE, PubMed, Cochrane Central Register).
- Complications were analyzed based on follow-up duration: 1-2 years, 2-5 years, and over 5 years.
- Subgroup and meta-regression analyses were performed to identify correlations.
Main Results:
- The study included 53 studies with 3223 patients.
- Pooled complication rates were generally low, with vascular adverse events at 0.8% and dysphagia at 4.7% short-term.
- ASDegeneration rates were significantly higher at long-term (36.0%) versus mid-term (7.3%) follow-up.
- Multivariate meta-regression revealed HO positively correlated with ASDegeneration at mid-term and long-term follow-up.
- Dysphagia showed an inverse association with HO, independent of age and follow-up duration.
Conclusions:
- Heterotopic ossification (HO) is significantly associated with adjacent segment degeneration (ASDegeneration) after CTDR.
- HO is also inversely associated with dysphagia following CTDR.
- This meta-analysis provides quantitative evidence on CTDR complication rates and the impact of HO.
Purpose:
Although cervical total disc replacement (CTDR) is perceived as a safe procedure, no review to date has quantified the complication rates. Of note, heterotopic ossification (HO), one of the complications of CTDR, is hypothesised to cause adjacent segment degeneration (ASDegeneration). This association has not been proven in meta-analysis. Hence, this systematic review and meta-analysis aims to investigate the pooled prevalence of complications following CTDR among studies that concomitantly reported the rate of HO, and the associations between HO and other complications, including ASDegeneration.
Methods:
Literatures search was conducted in Embase, MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials. Complications were stratified into ≥ 1 and < 2 years, ≥ 2 and < 5 years, and ≥ 5 years follow-up. Subgroup and meta-regression analyses were performed.
Results:
Fifty-three studies were included, composed of 3223 patients in total. The pooled prevalence of post-operative complications following CTDR was low, ranging from 0.8% in vascular adverse events to 4.7% in dysphagia at short-term follow-up. The rate of ASDegeneration was significantly higher at long-term follow-up (pooled prevalence 36.0%, 95% confidence interval [CI] 22.8-49.1%) than that at mid-term follow-up (pooled prevalence 7.3%, 95% CI 2.8-11.8%). Multivariate meta-regression analysis demonstrated that ASDegeneration was independently and inversely correlated with age (p = 0.007) and positively correlated with HO (p = 0.010) at mid-term follow-up. At long-term follow-up, ASDegeneration was still positively correlated with HO (p = 0.011), but not age. Furthermore, dysphagia was inversely associated with HO (p = 0.016), after adjustment for age and length of follow-up.
Conclusion:
In conclusion, HO is associated with ASDegeneration and dysphagia.
