The degeneration of uncovertebral joints on CT assessment and its association with postoperative heterotopic ossification in one- or two-level artificial cervical arthroplasty.
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引用次数: 0
Abstract
Background: Artificial cervical arthroplasty (ACR) preserves segmental mobility and reduces adjacent segment degenerative disease risk, yet postoperative heterotopic ossification (HO) impairs prosthetic function. Preoperative uncovertebral joint degeneration (UJD) is hypothesized to relate to HO. This study evaluated UJD on computed tomography (CT) and explored its association with HO after one- or two-level ACR, adjusting for confounders.
Methods: Forty patients undergoing one- or two-level ACR with a ≥1-year follow-up (2013-2019) were enrolled. UJD was graded using a modified Kellgren-Lawrence (K-L) CT system; final follow-up HO was assessed on radiographs using the McAfee classification. Generalized estimating equations (GEE) were used to address intrapatient clustering and confounders. Binary and ordinal logistic GEE, including proportional odds testing and sensitivity analyses, assessed independent UJD-HO associations. Stratified Spearman correlations were applied only for exploratory subgroup analyses.
Results: Overall HO incidence was 92.0%, with four segments at McAfee grade 0. After adjusting for age, sex, follow-up duration, operative level number and preoperative range of mobility, GEE showed non-significant trends linking higher-grade UJD to greater HO occurrence [adjusted odds ratio (aOR) = 12.561, 95% CI 0.885-178.247, P = 0.061] and severity (aOR = 1.493, 95% CI 0.863-2.585, P = 0.152). Partial proportional odds sensitivity analyses showed consistent results. Severe HO distribution imbalance and a scarcity of HO-negative segments led to unstable effect estimates and wide confidence intervals.
Conclusions: After adjusting for intrapatient clustering and confounders, preoperative UJD was not an independent predictor of HO onset or progression after ACR. Despite a positive trend, the high HO incidence caused a ceiling effect and limited statistical power, and thus, UJD's predictive value could not be confirmed. This CT-based modified K-L grading system reliably quantifies UJD and supports preoperative imaging evaluation for ACR candidates.
背景：人工颈椎关节置换术（ACR）保留了节段的活动能力，降低了相邻节段退行性疾病的风险，但术后异位骨化（HO）损害了假体功能。术前无椎关节退变（UJD）被认为与HO有关。本研究在计算机断层扫描（CT）上评估UJD，并探讨其与一级或二级ACR后HO的关系，调整混杂因素。方法：纳入40例接受一级或二级ACR治疗的患者，随访≥1年（2013-2019）。使用改进的Kellgren-Lawrence (K-L) CT系统对UJD进行分级；使用McAfee分级在x线片上评估最终随访HO。使用广义估计方程（GEE）来处理患者内聚类和混杂因素。二元和有序逻辑GEE，包括比例优势检验和敏感性分析，评估独立的UJD-HO关联。分层Spearman相关性仅用于探索性亚组分析。结果：总体HO发生率为92.0%，其中4节段McAfee评分为0级。在调整年龄、性别、随访时间、手术级别和术前活动范围后，GEE显示高级别UJD与高级别HO发生率[调整优势比(aOR) = 12.561, 95% CI 0.885-178.247, P = 0.061]和严重程度（aOR = 1.493, 95% CI 0.863-2.585, P = 0.152）之间无显著趋势。部分比例优势敏感性分析结果一致。严重的HO分布不平衡和HO负片段的稀缺性导致效应估计不稳定和置信区间宽。结论：在调整了患者内聚类和混杂因素后，术前UJD并不是ACR后HO发病或进展的独立预测因子。尽管呈正趋势，但高的HO发生率造成了天花板效应，统计效力有限，因此UJD的预测价值无法得到证实。这种基于ct的改进K-L分级系统可靠地量化了UJD，并支持ACR候选人的术前影像学评估。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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