Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up
Petr Suchomel, Lubomír Jurák, 3rd Benes, Vladimír, Radim Brabec, Ondrej Bradác, Shamel Elgawhary
DOI: 10.1007/s00586-009-1259-3
Klíčová slova: Adult, Ankylosis, ankylóza, bolest - měření, Cervical Vertebrae, čas, časové faktory, Disability Evaluation, Diskectomy, dospělí, Female, Follow-Up Studies, Head Movements, hlava - pohyby, Humans, Internal Fixators, interní fixátory, Intervertebral Disc Displacement, klouby - rozsah pohybu, krční obratle, krk - bolest, lidé, lidé středního věku, Male, meziobratlová ploténka - ektomie, Middle Aged, mužské pohlaví, následné studie, Neck Pain, neschopnost - posuzování, osifikace heterotopická, Ossification, Heterotopic, Pain Measurement, páteř - fúze, pooperační komplikace, Postoperative Complications, Range of Motion, Articular, recidiva, Recurrence, Spinal Fusion, stres mechanický, Stress, Mechanical, Time, Time Factors, výhřez meziobratlové ploténky, Weight-Bearing, zatížení (muskuloskeletálního systému), ženské pohlaví
Anotace: Cervical total disc replacement (CTDR) aims to decrease the incidence of adjacent segment disease through motion preservation in the operated disc space. Ongoing data collection and increasing number of studies describing heterotopic ossification (HO) resulting in decreased mobility of implants, forced us to carefully evaluate our long-term clinical and morphological results of patients with CTDR. We present the first 54 consecutive patients treated with 65 ProdiscC prostheses during a 12-month period (2/2004-3/2005). All patients signed an informed consent and were included in prospective long-term study approved by hospital ethical committee. The 1- and 2-year follow-up analysis were available for all patients included and 4-year results for 50 patients (60 implants). Clinical (neck disability index-NDI, visual analog scale-VAS) and radiological follow-up was conducted at 1-, 2- and 4-years after the procedure. The Mehren/Suchomel modification of McAfee scale was used to classify the appearance of HO. Mean preoperative NDI was 34.5%, VAS for neck pain intensity 4.6 and VAS for arm pain intensity 5.0. At 1-, 2- and 4-year follow-up, the mean NDI was 30.7, 27.2, and 30.4, mean VAS for neck pain intensity 2.5, 2.1 and 2.9 and mean VAS for arm pain intensity pain 2.2, 1.9 and 2.3, respectively. Significant HO (grade III) was present in 45% of implants and segmental ankylosis (grade IV) in another 18% 4 years after intervention. This finding had no clinical consequences and 92% of patients would undergo the same surgery again. Our clinical results (NDI, VAS) are comparable with fusion techniques. Although, advanced non-fusion technology is used, a significant frequency of HO formation and spontaneous fusion in cervical disc replacement surgery must be anticipated during long-term follow-up.
Citace: SUCHOMEL, Petr, Lubomír JURÁK, 3rd BENES, VLADIMÍR, Radim BRABEC, Ondrej BRADÁC a Shamel ELGAWHARY. Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2010, 19(2), 307-315. ISSN 14320932. Dostupné z: doi:10.1007/s00586-009-1259-3