• Xia-Qing Sheng, Ting-Kui Wu, Hao Liu, and Yang Meng.
• Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
• Spine. 2023 Jul 1; 48 (13): E203E215E203-E215.

Study DesignSystematic review and meta-analysis.ObjectiveThis study aimed to assess the incidence of heterotopic ossification (HO) 10 years after cervical disk replacement (CDR).Summary Of Background DataHO is a common complication after CDR and may limit the range of motion of the artificial disk. As HO usually progresses slowly, a long-term follow-up is required to better understand its incidence. In recent years, the increasing number of original articles reporting 10-year outcomes gives us the opportunity to better understand the long-term incidence of HO.Materials And MethodsWe searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The incidence of HO was pooled, and subgroup analysis was performed. Meta-regression analyses were conducted to identify factors contributing to heterogeneity.ResultsEleven studies with at least 10 years of follow-up comprising 1140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI, 60%-81%) at 10 years postoperatively, 60% (95% CI, 44%-75%) at five or six years postoperatively, and 50% (95% CI, 27%-72%) at one or two years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI, 29%-45%), and mild HO (grade 1 to 2) was 30% (95% CI, 17%-44%) at 10 years of follow-up. Pooled range of motion decreased from 8.59° before surgery to 7.40° 10 years after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type. The earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis.ConclusionsThis is the first meta-analysis providing detailed information on the pooled 10-year incidence of HO after CDR. The incidence of HO seems to increase with the length of follow-up.Level Of Evidence3.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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