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

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.

Figure 1

Flow diagram of study selection process in the meta-analysis.

Figure 2

Forest plot showing subgroup analysis results of the prevalence of HO (A) and severe HO (B) after cervical artificial disc replacement.

Figure 3

Column diagram showing the prevalence of HO and severe HO at different follow-up period.

Figure 4

Scatter diagram showing the relationship between the prevalence of severe HO and length of follow-up time. The line represents point estimates of association between mean length of follow-up and the prevalence of severe HO; dots represent the follow-up-specific prevalence reported in different studies.

Figure 5

Funnel plots of the included studies in this meta-analysis for HO (A) and severe HO (B).