Hui Nicholas, Phan Kevin, Kerferd Jack, Lee Meiyi, Mobbs Ralph Jasper
NeuroSpine Surgery Research Group, Sydney, Australia.
Faculty of Medicine, University of New South Wales, Sydney, Australia.
Asian Spine J. 2021 Feb;15(1):127-137. doi: 10.31616/asj.2019.0234. Epub 2020 Feb 14.
Anterior cervical discectomy and fusion (ACDF) immobilizes surgical segments and can lead to the development of adjacent segment degeneration and adjacent segment disease. Thus, cervical total disc replacement (CTDR) has been developed with the aim to preserve the biomechanics of spine. However, heterotopic ossification (HO), a complication following CTDR, can reduce the segmental range of motion (ROM) and defects the motion-preservation benefit of CTDR. The pathological process of HO in CTDR remains unknown. HO has been suggested to be a self-defense mechanism in response to the non-physiological biomechanics of the cervical spine following CTDR. The current literature review is concerned with the association between the biomechanical factors and HO formation and the clinical significance of HO in CTDR. Endplate coverage, disc height, segmental angle, and center of rotation may be associated with the development of HO. The longer the follow-up, the higher the rate of ROM-limiting HO. Regardless of the loss of motion-preservation benefit of CTDR in patients with HO, CTDR confers patients with a motion-preservation period before the development of ROM-limiting HO. This may delay the development of adjacent segment degeneration compared with ACDF. Future clinical studies should explore the association between HO and changes in biomechanical factors of the cervical spine.
颈椎前路椎间盘切除融合术（ACDF）可固定手术节段，并可能导致相邻节段退变和相邻节段疾病的发生。因此，为了保留脊柱的生物力学特性，人们开发了颈椎全椎间盘置换术（CTDR）。然而，异位骨化（HO）作为CTDR术后的一种并发症，会降低节段活动度（ROM），削弱CTDR的运动保留益处。CTDR中HO的病理过程尚不清楚。有人认为HO是对CTDR术后颈椎非生理性生物力学的一种自我防御机制。当前的文献综述关注生物力学因素与HO形成之间的关联以及HO在CTDR中的临床意义。终板覆盖、椎间盘高度、节段角度和旋转中心可能与HO的发生有关。随访时间越长，ROM受限型HO的发生率越高。尽管HO患者的CTDR失去了运动保留益处，但CTDR在ROM受限型HO发生之前为患者提供了一个运动保留期。与ACDF相比，这可能会延迟相邻节段退变的发生。未来的临床研究应探索HO与颈椎生物力学因素变化之间的关联。
