Heterotopic ossification in cervical total disk replacement: A finite element analysis

Ganbat, Danaa; Kim, Kyung-Soo; Jin, Yong Jun; Kim, Yoon Hyuk

doi:10.1177/0954411914522024

Cited by 14 publications

(15 citation statements)

References 33 publications

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“…The biomechanical advantage of CDA has been demonstrated previously that it can maintain segmental range of motion and cervical kinematics, theoretically reducing or avoiding adjacent segment degeneration [ 12 – 16 ]. However, CDA has its own potential disadvantages, such as higher incidence of heterotopic ossification [ 17 – 20 ] and implant migration or subsidence [ 21 – 24 ]. Many investigators have reported RCTs comparing CDA with ACDF for the treatment of symptomatic cervical disc disease [ 25 – 41 ].…”

Section: Introductionmentioning

confidence: 99%

Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

Ren

Johansen

2016

PLoS ONE

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PurposeThis study aimed to investigate the mid- to long-term outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of 1-level or 2-level symptomatic cervical disc disease.MethodsMedline, Embase, and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant randomized controlled trials that reported mid- to long-term outcomes (at least 48 months) of CDA versus ACDF. All data were analyzed by Review Manager 5.3 software. The relative risk (RR) and 95% confidence intervals (CIs) were calculated for dichotomous variables. The weighted mean difference (WMD) and 95%CIs were calculated for continuous variables. A random effect model was used for heterogeneous data; otherwise, a fixed effect model was used.ResultsEight prospective randomized controlled trials (RCTs) were retrieved in this meta-analysis, including 1317 and 1051 patients in CDA and ACDF groups, respectively. Patients after an ACDF had a significantly lower rate of follow-up than that after CDA. Pooled analysis showed patients in CDA group achieved significantly higher rates of overall success, Neck Disability Index (NDI) success, neurological success and significantly lower rates of implant/surgery-related serious adverse events and secondary procedure compared with that in ACDF group. The long-term functional outcomes (NDI, Visual Analog Scale (VAS) neck and arm pain scores, the Short Form 36 Health Survey physical component score (SF-36 PCS)), patient satisfaction and recommendation, and the incidence of superior adjacent segment degeneration also favored patients in CDA group with statistical difference. Regarding inferior adjacent segment degeneration, patients in CDA group had a lower rate without statistical significance.ConclusionsThis meta-analysis showed that cervical disc arthroplasty was superior over anterior discectomy and fusion for the treatment of symptomatic cervical disc disease in terms of overall success, NDI success, neurological success, implant/surgery-related serious adverse events, secondary procedure, functional outcomes, patient satisfaction and recommendation, and superior adjacent segment degeneration.

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Section: Introductionmentioning

confidence: 99%

Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

Ren

Johansen

2016

PLoS ONE

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“…The ectopic bone models previously developed (He and Xinghua 2006;Ganbat et al 2014) are appropriate for ectopic bone cases where mechanical stimuli are the main influence. It is accepted that osteophytes may form in response to the modified loading caused by degenerative changes in the vertebral discs.…”

Section: Resultsmentioning

confidence: 99%

“…The feedback can be considered as the error between some experienced stimulus and a steady state stimulus value. Previous authors have used a strain energy based modelling approach to model osteophytes (He and Xinghua 2006) and the development of ectopic bone formed after total disc replacement (Ganbat et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Simulating localised cellular inflammation and substrate properties in a strain energy density based bone remodelling algorithm for use in modelling trauma

Rosenberg

Bull

2018

Computer Methods in Biomechanics and Biomedical Engineering

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Bone responds to mechanical stimulus and a range of pre-existing finite element models have been suggested to reproduce the internal physiological structure of bone. Inflammation effects are not included in these models, yet inflammation is a key component of bone repair in trauma. Therefore, a model is proposed and tested here that extends these methods to include parameters that could be considered to represent the behaviour of bone remodelling when influenced by inflammation. The proposed model regulates remodelling based on findings from recent studies into the nature of heterotopic ossification, the formation of heterotopic bone, which have revealed information about the nature of bone after high levels of trauma. These parameters include consideration of the distance from the zone of trauma, the density of mesenchymal stem cells, and substrate stiffness as a trigger for cells becoming osteogenic. The method is tested on a two-dimensional plate model and shows that the new extended algorithm can produce a range of structures depending on inputs that could be used in the future to replicate physiological scenarios.

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“…Ganbat et al . investigated HO formation after total disc replacement (TDR), and these studies were the first studies on HO formation using the bone adaptation process 18,19 . However, the ExGBF after ACDF has not been simulated, and its biomechanical effects on the operated spine have not been studied.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical investigation of extragraft bone formation influences on the operated motion segment after anterior cervical spinal discectomy and fusion

Park¹,

Jin²

2019

Sci Rep

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Although the clinical importance of extragraft bone formation (ExGBF) and bridging (ExGBB) has been reported, few studies have investigated the biomechanical influences of ExGBF on the motion segment. In this study, ExGBF was simulated at the C5-C6 motion segment after anterior cervical discectomy and fusion using a developed finite element model and a sequential bone-remodelling algorithm in flexion and extension. The computer simulation results showed that extragraft bone was primarily formed in the extension motion and grew to form ExGBB. A stepwise decrease in the intersegmental rotation angle, maximum von Mises stress and strain energy density on the trabecular bone with ExGBF were predicted in extension. When ExGBB was formed in the trabecular bone region, the intersegmental rotation angle slightly decreased with additional bone formation. However, the stress and strain energy density on the trabecular bone region decreased until ExGBB reached the peripheral cortical margin. The results offer a rationale supporting the hypothesis that mechanical stimuli influence ExGBF. ExGBF was helpful in increasing the stability of the motion segment and decreasing the fracture risk of trabecular bones, even in cases in which ExGBB was not formed. ExGBB can be classified as either soft or hard bridging based on a biomechanical point of view.

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Heterotopic ossification in cervical total disk replacement: A finite element analysis

Cited by 14 publications

References 33 publications

Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

Simulating localised cellular inflammation and substrate properties in a strain energy density based bone remodelling algorithm for use in modelling trauma

Biomechanical investigation of extragraft bone formation influences on the operated motion segment after anterior cervical spinal discectomy and fusion

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