Kazarian Gregory S, Cecere Robert, Sheha Evan, Dowdell James, Iyer Sravisht, Qureshi Sheeraz
Department of Spine Surgery, Hospital for Special Surgery, New York City, NY.
Spine (Phila Pa 1976). 2024 Oct 15;49(20):1445-1455. doi: 10.1097/BRS.0000000000005110. Epub 2024 Jul 30.
Systematic review and meta-analysis.
Describe the impact of endplate coverage on HO in cervical disc replacement (CDR).
CDR is a motion-sparing alternative to anterior cervical discectomy and fusion. However, the high prevalence of heterotopic ossification threatens to diminish range of motion and limit this benefit associated with CDR.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE and PubMed databases were queried. Results were deduplicated and screened. Relevant studies were included. All metrics that were reported in ≥3 studies were aggregated for analysis. SPSS was used to perform the meta-analysis.
A total of 10 studies were included in the systematic review. Endplate coverage was assessed using a wide variety of measurements, including anteroposterior implant depth (ID), endplate depth (ED), exposed endplate depth (EED), implant depth to endplate depth ratio (ID:ED), EED to ED ratio (EED:ED), implant width (IW) to endplate width (EW) ratio (IW:EW), and the implant area (IA) to endplate area (EA) ratio (IA:EA). No evidence has linked ID (three studies) to HO. Mixed evidence has linked ID:ED (3/5) and IW:ED (1/2) to HO. All available evidence has linked ED (2), EED (4), EED:ED (2), and IA:EA (1) to HO. In our meta-analysis, ID was not found to be a significant risk factor for HO. However, EED and ID:ED were found to be significant risk factors for HO formation.
Exposed endplate, especially as assessed by EED and ID:ED, is a significant risk factor for HO. Surgeons should focus on preoperative planning and intraoperative implant selection to maximize endplate coverage. While optimizing technique and implant selection is crucial, improved implant design may also be necessary to ensure that appropriate implant-endplate footprint matching is possible across the anatomic spectrum.
系统评价与荟萃分析。
描述终板覆盖对颈椎间盘置换术（CDR）中异位骨化（HO）的影响。
CDR是一种保留运动功能的替代前路颈椎间盘切除融合术的方法。然而，异位骨化的高发生率可能会减少活动范围并限制与CDR相关的益处。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价。检索了EMBASE和PubMed数据库。对结果进行去重和筛选。纳入相关研究。汇总在≥3项研究中报告的所有指标进行分析。使用SPSS进行荟萃分析。
系统评价共纳入10项研究。使用多种测量方法评估终板覆盖情况，包括前后位植入物深度（ID）、终板深度（ED）、暴露终板深度（EED）、植入物深度与终板深度之比（ID:ED）、EED与ED之比（EED:ED）、植入物宽度（IW）与终板宽度（EW）之比（IW:EW）以及植入物面积（IA）与终板面积（EA）之比（IA:EA）。没有证据表明ID（三项研究）与HO有关。有混合证据表明ID:ED（3/5）和IW:ED（1/2）与HO有关。所有现有证据都表明ED（2项研究）、EED（4项研究）、EED:ED（2项研究）和IA:EA（1项研究）与HO有关。在我们的荟萃分析中，未发现ID是HO的显著危险因素。然而，发现EED和ID:ED是HO形成的显著危险因素。
暴露的终板，尤其是通过EED和ID:ED评估的，是HO的显著危险因素。外科医生应专注于术前规划和术中植入物选择，以最大限度地覆盖终板。虽然优化技术和植入物选择至关重要，但可能还需要改进植入物设计，以确保在整个解剖范围内能够实现合适的植入物-终板接触面积匹配。
