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      The prevalence of heterotopic ossification among patients after cervical artificial disc replacement : A systematic review and meta-analysis

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          Abstract

          Background:

          Prevalence estimates of heterotopic ossification (HO) following cervical artificial disc replacement (ADR) varied widely in previous studies. We conducted a systematic review and meta-analysis to summarize its point prevalence.

          Methods:

          Electronic searches of PubMed, Web of Science, Embase, and Cochrane Library databases were conducted to identify studies that reported prevalence of HO. Definitions of HO and severe HO were based on McAfee grading system. Random-effects model was used to estimate the pooled prevalence. We conducted subgroup analyses according to the different length of follow-up time, and performed univariate metaregression analyses to explore the effects of potential variables on the overall prevalence.

          Results:

          A total of 38 studies were included in this study. The pooled data showed that the prevalence of HO after cervical ADR within the 1 to 2 years, 2 to 5 years, and 5 to10 years of follow-up was 38.0% (95% confidence interval [CI], 30.2%–46.5%), 52.6% (95% CI, 43.1%–61.9%), and 53.6% (95% CI, 40.0%–66.7%), respectively, while the prevalence of severe HO was 10.9% (95% CI, 9.0%–13.2%), 22.2% (95% CI, 15.5%–30.7%), and 47.5% (95% CI, 30.0%–65.8%), respectively. Follow-up time was positively associated with the prevalence of severe HO ( P < .01), and the 1-month growth of mean follow-up went with 0.63% increase of severe HO.

          Conclusion:

          This meta-analysis reported data on the prevalence of HO and severe HO after cervical ADR, and provided information on its process of development. These should be useful to enable surgeons and patients to gain a better understanding of HO after cervical ADR.

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          Most cited references42

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          Critical appraisal of the health research literature: prevalence or incidence of a health problem.

          This article identifies and discusses criteria that can be used by health professionals to critically appraise research articles that estimate the prevalence or incidence of a disease or health problem. These guidelines will help determine the validity and usefulness of such community assessment studies. The criteria relate to the validity of the study methods (design, sampling frame, sample size, outcome measures, measurement and response rate), interpretation of the results and applicability of the findings. The research question "What is the prevalence of dementia in Canada?" is used as an example for this paper.
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            Classification of heterotopic ossification (HO) in artificial disk replacement.

            There is currently no structured classification system to quantitate heterotopic bone formation after artificial disk replacement procedures. The purpose of this work was to develop a method of classifying heterotopic bone formation that is reliable between investigators with different levels of training and easy to remember with only five gradations of severity. One hundred one radiographs of clinical patients and 17 microradiographs from nonhuman primates having undergone various types of disk replacement were classified by seven independent reviewers. The kappa statistics were calculated for interobserver variation between the seven participants with various levels of spinal training and the intraobserver error based on two assessments made at least 2 months apart. The interobserver reliability correlation coefficient for seven raters calculated using the intraclass kappa correlation coefficient and the Kish rho was r = 0.9683 (P < 0.0001). The intraobserver reliability based on readings at two time intervals at a minimum of 2 months apart was r = 0.8949 (P = 0.01). This classification of heterotopic ossification, periannular calcification, and ectopic bone formation associated with total disk arthroplasty proved to be highly reliable and reproducible.
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              Heterotopic ossification in total cervical artificial disc replacement.

              Prospective clinical study enrolled in 2 centers (Munich and Liberec) as part of a prospective European multicenter study with ProDisc C (Synthes Inc., Paoli, PA). The first goal of the study was to evaluate the rate of heterotopic ossifications identified with plain radiograph following total cervical disc replacement (TCDR). The second goal was to show whether segmental motion can be preserved, and whether TCDR can provide improvement of the patient's ability to perform activities of daily living as well as a decrease of pain. Only a few reports about the radiologic outcome after TCDR are published so far. Heterotopic ossification is a well-known phenomenon after total hip arthroplasty. The rate of heterotopic ossification following TCDR is unclear. The radiographs of 54 patients (in total, 77 implanted prostheses) were analyzed 1 year after TCDR with a ProDisc C prosthesis. We classified the heterotopic ossification in 5 grades according to a recently published classification system for lumbar total disc replacement. For clinical parameters, the visual analog scale and the Neck Disability Index were evaluated preoperatively and 1 year postoperatively. The Student t test and Wilcoxon test were used for statistical analysis. In 26 treated segments (33.8%), no heterotopic ossification was detectable. Grade 1 ossifications were present in 6 levels (7.8%). A total of 30 segments (39.0%) showed grade 2 ossifications. Heterotopic ossifications that led to restrictions of the range of motion were present in 8 cases (10.4%). One year postoperatively, 7 cases (9.1%) had a spontaneous fusion of the treated segment. The clinical parameters improved significantly and were similar to previous reports about TCDR. Only 33.8% of the patients did not show any signs of heterotopic ossification, and the rate of spontaneous fusion after TCDR 1 year after surgery was unexpectedly high. There were 49.4% of the patients with grade 2-3 ossification, which lets us suspect an even higher rate of spontaneous fusion after long-term follow-ups. Motion preservation after TCDR is only guaranteed if spontaneous fusion can be prevented. Thus, mobility of the implanted segments needs to be further studied.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                June 2017
                16 June 2017
                : 96
                : 24
                : e7163
                Affiliations
                Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
                Author notes
                []Correspondence: Yong Shen, Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei 050051, P.R. China (e-mail: shenyongspine@ 123456126.com ).
                Article
                MD-D-17-00497 07163
                10.1097/MD.0000000000007163
                5478335
                28614250
                c244ef1b-f2e9-43ca-b2ca-1b8ac4fc7050
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 22 January 2017
                : 4 May 2017
                : 24 May 2017
                Categories
                7100
                Research Article
                Systematic Review and Meta-Analysis
                Custom metadata
                TRUE

                cervical artificial disc replacement,heterotopic ossification,meta-analysis,prevalence,review

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