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<p><b>OBJECTIVE</b>To compare the clinical effects and clinical indications between Mobi-C cervical artificial disc replacement (CADR) and MC+ anterior cervical decompression and fusion(ACDF) in treating cervical spondylosis.</p><p><b>METHODS</b>The clinical data of 100 patients with cervical spondylosis treated ACDF or CADR from June 2009 to June 2015 were retrospectively analyzed. There were 53 males and 47 females, aged from 38 to 70 years old. Among them, 50 cases were treated by ACDF (ACDF group), follow-up time was for 22 to 42 months with an average of (32.24±5.20) months;other 50 cases were treated by CADR (CADR group), follow-up time was for 23 to 48 months with an average of (30.40±5.66) months. Odom criterion was used to evaluate the clinical effects in two groups. JOA score, including sensory function, motor function and bladder function was used to assess the spinal cord function. Preoperative and postoperative responsible intervertebral space heights, cervical curvatures were compared by image data between two groups.</p><p><b>RESULTS</b>All incisions obtained good healing and no serious complications were found. At final follow-up, 30 cases got excellent results, 12 good, 8 fair in ACDF group;and 34 cases got excellent results, 10 good, 6 fair in CADR group;there was no significant difference between two groups(u=4.000, =0.827). At final follow-up, the scores of sensory function and motor function were obviously improved(<0.05), and bladder function had not obviously recovered (>0.05) in two groups;and CADR group in the scores of sensory function and motor function were obviously better than of ACDF group(<0.05). There was no significant difference in preoperative intervertebral space height, cervical curvature between two groups, and at final follow-up both had different recovered. The recovery of CADR group was obviously better than of ACDF group.</p><p><b>CONCLUSIONS</b>CADR can quickly recover normal action for patients and retains the movement. CADR has certain advantages in recovering cervical curvature, improveing sensory function and motor function, but it is not able to completely replace ACDF.</p>
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Objective: To evaluate the influence of the shell angle of cervical artificial disc on long-term effectiveness of cervical artificial disc replacement (CADR). Methods: The clinical data of 71 patients who were treated with single-level CADR with Bryan prosthesis between December 2003 and December 2007 and followed up more than 10 years, were retrospectively analyzed. There were 44 males and 27 females with an age of 26-69 years (mean, 45.9 years). According to the shell angle of the cervical artificial disc which was measured on the postoperative lateral X-ray film, the patients were divided into kyphotic group (shell angle was negative) and non-kyphotic group. The following evaluation indexes before operation and at last follow-up were compared between 2 groups. Radiographic indexes included the range of motion (ROM) of cervical spine, the ROM of operated level, Cobb angle of operated level (the negative value indicated that the segmental kyphosis occurred at operated level), paravertebral ossification (PO) grades (grades 3 and 4 were high grade PO). Clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and overall effectiveness evaluation (Odom criteria). Results: There were 24 patients in kyphotic group and 47 patients in non-kyphotic group. There was no significant difference in baseline data including gender, age, and operated level between 2 groups ( P>0.05). All the patients in 2 groups were followed up 121-165 months (mean, 128 months). There was no significant difference in preoperative ROM of cervical spine and ROM of operated level between 2 groups ( P>0.05); but the preoperative Cobb angle of operated level in kyphosis group was significantly lower than that in non-kyphotic group ( t=2.636, P=0.013). There was no significant difference in ROM of cervical spine at last follow-up between 2 groups ( t=1.393, P=0.168), however, the ROM and the Cobb angle of operated level in kyphotic group were significantly lower than those in non-kyphotic group ( P0.05). Conclusion: The shell angle of cervical artificial disc may lead to a decrease in the postoperative segmental ROM, and an increased occurrence of segmental kyphosis and high incidence of PO.
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Objective: To evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement (CADR) for patients with cervical spondylotic radiculopathy (CSR). Methods: The data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than 10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years (range, 40-70 years). The disease duration was 2-144 months (mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments (C 3, 4 in 2 cases, C 4, 5 in 6 cases, C 5, 6 in 18 cases, C 6, 7 in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups ( P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion (ROM), loss of ROM (ROM0.05). Except that the loss of ROM (ROM0.05). The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups ( P0.05). The excellent and good rate of overall efficacy reached 100% in both groups. Conclusion: CADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.
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The authors describe the revision case of a 58-year-old man who presented with pain in the neck and both shoulders after C4-5 cervical total disc replacement (C-TDR) and C5-6 anterior cervical discectomy and fusion (ACDF), and in whom there was evidence of instability with sagittal translation at the C4-5 TDR level and of a herniated cervical disc (HCD) at the left side of C3-4. The revision surgery was performed as follows: previous plate removal at the C5-6 level, artificial disc removal and ACDF at the C4-5 level with cage and previous plate insertion, and TDR at the C3-4 level using the previously implanted C4/5 artificial disc. If instability develops at the level of an artificial disc, we perform additional posterior fusion or anterior removal of the artificial disc and fusion. However, if we encounter combined adjacent segment disc disease, we may reuse the unstable segment artificial disc at the adjacent segment and perform salvage anterior fusion on the unstable segment. This is the first report issued on the management of instability after previous C-TDR involving a switch to ACDF and the use of new TDR at the adjacent level. Furthermore, we conceptually recommend a solution to an emerging problem of adjacent segment disease due to the heterotopic ossification(HO) after C-TDR.
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Humanos , Persona de Mediana Edad , Discectomía , Cuello , Osificación Heterotópica , Reciclaje , Hombro , Reeemplazo Total de DiscoRESUMEN
INTRODUCTION: Cervical anterior interbody fusion may be considered to be the gold standard for treatment of symptomatic cervical degenerative disc disease. However, this method leads to degenerative changes at the levels adjacent to the fused segments. On the other hand, multilevel cervical artificial disc replacement is another treatment for cervical degenerative disease, but the effectiveness and stability of artificial disc has not been proven yet. The purpose of this study is to compare the two-level hybrid surgery (Cervical disc prosthesis replacement at one level, and interbody fusion with cage at the other level) with the classical two-level interbody fusion in relation to the clinical outcomes and effects on the adjacent segment levels. METHOD: 27 patients with two-level cervical degenerative disease were enrolled and assigned to each study group. Radiologic analysis was used to measure the range of movement (ROM) of cervical spine, functional spinal unit (FSU) and adjacent segment levels at 2 months postoperatively and follow-up period (Mean follow-up period was 9.3(+/-4.1) month). Furthermore, clinical outcomes were analyzed by using visual analogue scale (VAS) and Odom..s criteria. RESULT: Out of 27 patients, 14 patients received hybrid surgery (group A) and 13 patients received two-level interbody fusion using a cage with bone graft (group B). Both groups showed significant improvement in symptoms and the VAS scores after operation (group A: from 8.2 to 2.4, group B: from 8.0 to 3.2). In group A, ROM of C2-7 decreased at 2 month postoperatively, but it was restored to nearly preoperative state during follow-up period. ROM of C2-7 in group B also showed similar changes, and there were no statistically significant difference between two groups (group A: pre-operation 44.3degrees, 2 months after operation 29.0degrees and last follow-up 41.6degrees, group B: pre-operation 46.8degrees, 2 months after operation 26.3degrees and last follow-up 37.4degrees). In both upper and lower segments, ROM of group B was significantly increased during follow-up period, compared with ROM of group A. This reflected that adjacent segments in group B received more stress due to bone fusion of functional spinal unit. CONCLUSION: The hybrid surgery was somewhat effective in two-level cervical degenerative disease. ROM analysis of adjacent segments in hybrid surgery group suggested that this group received less stress at adjacent segments, compared with two-level anterior cervical fusion group. Further follow-up study is required to assess long-term outcomes of the hybrid surgery and its influence on adjacent levels.