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Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic review and meta-analysis

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Abstract

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.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. NeuroSpine Surgery Research Group, Sydney, Australia

    Nicholas Hui, Kevin Phan & Ralph J. Mobbs

  2. Faculty of Medicine, University of New South Wales, Sydney, Australia

    Nicholas Hui, Kevin Phan, Hoi Man Kevin Cheng, Yueh-Hsin Lin & Ralph J. Mobbs

  3. NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia

    Ralph J. Mobbs

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  1. Nicholas Hui
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Hui, N., Phan, K., Cheng, H.M.K. et al. Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic review and meta-analysis. Eur Spine J 29, 2688–2700 (2020). https://doi.org/10.1007/s00586-020-06400-z

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