Association between anterior bone loss and anterior heterotopic ossification in hybrid surgery
Junbo He1, Hao Liu1, Tingkui Wu1
1Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China.
Insights
Anterior bone loss (ABL) is common after hybrid surgery (HS) for cervical disc disease and is associated with anterior heterotopic ossification (AHO). Both ABL and AHO may be part of bone remodeling post-surgery.
Area of Science:
- Spine surgery
- Orthopedics
- Biomedical engineering
Background:
- Hybrid surgery (HS) is a viable treatment for multilevel cervical degenerative disc disease.
- Adverse outcomes like heterotopic ossification (HO) and anterior bone loss (ABL) have been reported.
- The specific mechanisms and relationships of anterior HO (AHO) and ABL remain unclear.
Purpose of the Study:
- To investigate the incidence of ABL and AHO following two-level HS.
- To determine the relationship between ABL and AHO.
- To assess clinical outcomes in patients with and without AHO.
Main Methods:
- Retrospective analysis of 97 patients undergoing two-level HS.
- Minimum 2-year follow-up with radiographic and clinical outcome assessment.
- Evaluation of ABL and AHO incidence and severity.
Main Results:
- ABL occurred in 44.3% of patients.
- A significant association was found between ABL and AHO (P=0.016).
- Clinical outcomes improved post-surgery in both AHO and non-AHO groups without significant differences.
Conclusions:
- ABL is common in HS and is related to AHO.
- AHO formation may be an integral part of postoperative bone remodeling, alongside ABL.
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 two-level 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.
