Postoperative NSAID Prophylaxis is Associated with Decreased Rates of Heterotopic Ossification following Cervical...

Retrospective cohort study.

To identify factors associated with heterotopic ossification (HO) formation following cervical disc arthroplasty (CDA), including postoperative non-steroidal anti-inflammatory drug (NSAID) use.

CDA preserves segmental motion in treating cervical degenerative disc disease but is susceptible to HO formation, which may compromise surgical outcomes. While NSAID prophylaxis is well-established in total hip arthroplasty to reduce HO risk, its role in CDA remains underexplored.

A retrospective review was conducted at a single academic center using a maintained surgical registry. Patients undergoing CDA with at least 1-2 years of radiographic follow-up were included. Demographic variables, BMI, implant type, operative levels, and NSAID use (any reason vs. specifically for HO prophylaxis) within 48 hours postoperatively were collected. Radiographs were graded for HO severity using the McAfee classification. Two logistic regression analyses assessed associations between variables and HO formation. Patient-reported outcome measures (PROMs) and rates of complications and reoperations were compared between HO-positive and HO-negative groups.

Among 140 patients, 43.6% developed HO. HO presence was associated with higher age (P=0.025), higher BMI (P=0.002), and lower NSAID use both overall (P=0.018) and specifically for HO prophylaxis (P=0.005). Logistic regression confirmed that higher BMI was associated with increased HO risk, while postoperative NSAID use was associated with reduced risk. Clinical outcomes and PROMs improved significantly over time in both HO+ and HO- groups, with no significant differences in outcomes, complications, or reoperations.

Following multivariate analysis, higher BMI is associated with increased risk of HO following CDA, while early postoperative NSAID use is associated with a lower incidence. Clinical outcomes were similar between HO presence and absence groups. These findings support the potential role of NSAID prophylaxis in reducing HO development and guiding postoperative management following CDA.

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