• Jarle Sundseth, Eva Astrid Jacobsen, Frode Kolstad, Ruth O Sletteberg, Oystein P Nygaard, Lars Gunnar Johnsen, Are Hugo Pripp, Hege Andresen, Oddrun Anita Fredriksli, Erling Myrseth, and John A Zwart.
• Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950, Nydalen, 0424, Oslo, Norway. jsundset@ous-hf.no.
• Eur Spine J. 2016 Jul 1; 25 (7): 2271-8.

PurposeHeterotopic ossification is a phenomenon in cervical arthroplasty. Previous reports have mainly focused on various semiconstrained devices and only a few publications have focused on ossification around devices that are nonconstrained. The purpose of this study was to assess the occurrence of heterotopic ossification around a nonconstrained cervical device and how it affects clinical outcome 2 years after surgery.MethodsThirty-seven patients were included from a larger cohort of a randomized controlled trial (NORCAT) which compared single-level cervical arthroplasty with fusion. The occurrence of heterotopic ossification was assessed with a CT scan and two neuroradiologists determined its degree. For grading, we used the Mehren/Suchomel classification system (grade 0-4). The patients were divided by level of ossification, low grade (0-2) or high grade (3-4), and clinical outcomes were compared. Self-rated disability for neck and arm pain (Neck Disability Index), health-related quality of life (the Short Form-36 and EuroQol-5D), and pain (the Numeric Rating Scale 11) were used as clinical outcome measures.ResultsHeterotopic ossification was encountered in all patients 2 years after surgery. Complete fusion (grade 4) was found in 16 % of participants, and high-grade ossification (grade 3-4) occurred in 62 %. The remaining patients were classified as having low-grade ossification (grade 2). There were no differences in the clinical outcomes of patients with low- and high-grade ossification.ConclusionHigh-grade heterotopic ossification and spontaneous fusion 2 years after surgery were seen in a significant number of patients. However, the degree of ossification did not influence the clinical outcome.

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