RESUMO
<p><b>OBJECTIVE</b>To investigate the effect of Bryan cervical disc replacement on cervical curvature and replacement segment in the treatment of cervical spondylosis, and analyze its clinical efficacy.</p><p><b>METHODS</b>Forty-nine patients underwent Bryan artificial cervical disc replacement from August 2010 to August 2013 were retrospectively analyzed. There were 26 males and 23 females, aged from 27 to 66 years old with an average of 48.5 years. Including 21 cases of nerve root type, 16 cases of spinal cord type, 12 cases of mixed type. And 21 cases were single segment replacement, 28 cases were double segments replacement. Preoperative and postoperative pain was compared using visual analogue scale(VAS);cervical function was observed by Japanese Orthopedic Association Scores (JOA) and Neck Disability Index (NDI);cervical lordosis curvature, function spinal unit(FSU) curvature, activities of replacement and adjacent segment, FSU activity were measured by cervical X-rays. Clinical effects were evaluated by the Odom method.</p><p><b>RESULTS</b>All the patients were followed up for 18.5 to 37.3 months with an average of 33.1 months. Pvoperative VAS, JOA, NDI scores were 7.08±1.55, 5.2±1.9, 39.96±7.06 before operation, 3.76±2.33, 13.20±1.20, 25.20±6.64 at 3 months after operation, and 2.80±1.50, 14.3±1.6, 24.24±7.89 at the last follow-up. Patients at three months and the last follow-up after operation were obviously improved in their VAS, JOA, and NDI scores (<0.05). There was no significant difference between the scores at last follow-up and 3 months after operation. Cervical lordosis changed from (10.64±4.26)° preoperatively to (13.68±4.56) ° at the last follow-up;the FSU curvature from (5.40±0.41) °to (9.92±2.00) °at the last follow-up (<0.05). The range of motion of the cervical spine preoperatively, 3 month postoperatively, and at the last follow-up were(70.84±6.17)°, (60.00±6.58)°, (71.48±4.61)°; FSU activities were(12.00±0.49)°, (9.36±0.26)°, (12.52±0.33)°;the activities of replacement segment were (10.48±0.67)°, (7.24±0.34)°, (9.28±0.36)°;the activities of upper segment of replacement were (10.52±0.60)°, (8.60±0.30)°, (10.44±0.43)°;the activities of lower segment of replacement were (8.48±0.40)°, (6.56±0.36)°, (9.60±0.39)°;there were significant differences in above items preoperatively and 3 months postoperatively(<0.05); and there were no significant difference preoperatively and at the last follow-up(>0.05). Pharyngeal discomfort and hoarseness occurred in 5 cases, and were recovered within 2 weeks after operation;heterotopic ossification occurred in 1 case at 6 months after operation;displacement of prosthesis occurred in 1 case at 12 months after operation. Based on Odom standard to evaluate the clinical outcome, 20 cases obtained excellent results, with 27 good, 2 general.</p><p><b>CONCLUSIONS</b>Bryan artificial cervical disc replacement not only generate good clinical effects, but may also restore the cervical lordosis and FSU curvature, while retaining the activities of replacement segment, and restoring overall cervical biomechanical functions.</p>
RESUMO
<p><b>OBJECTIVE</b>To explore the clinical effects and significances of a cervical anterior Hybrid technique with posterior longitudinal ligament retained in treating cervical spondylosis.</p><p><b>METHODS</b>The clinical data of 138 patients with cervical spondylosis underwent cervical anterior Hybrid surgery were retrospectively analyzed from March 2009 to March 2013. There were 52 males and 86 females,the age ranged from 36 to 58 years old with an average of 45.3 years. Course of disease was from 3 to 16 months. Cervical spondylosis classification included 22 cases with nerve root type, 68 cases with myelopathic type, 48 cases with mixed type. All patients were treated with the primary Hybrid surgery and their cervical posterior longitudinal ligaments were retained in anterior decompression. JOA score and image examination were used to evaluate clinical effect, and image examination included range of motion of the replacement segment, range of motion of the whole cervical spine, the sagittal diameter of the spinal cord before and after operation.</p><p><b>RESULTS</b>All operations were successful and operation time was 60 to 125 min (averaged 90.6 min), perioperative bleeding was 10 to 60 ml (averaged 30.1 ml). All patients were followed up from 12 to 48 months with an average of 22.2 months. All pathological segments obtained fully decompression, reserved posterior longitudinal ligament had no obvious hypertrophy, proliferation and calcification. The prosthesis had good location and the incision healed well without complications. Upper limbs root symptoms were completely relieved in the patients with cervical spondylotic radiculopathy, muscle strengths and sensations got different recovery in the patients with cervical spondylotic myelopathy. JOA score was increased from preoperative 8.62±1.22 to final follow-up 14.26±1.47 (P<0.05). Artificial intervertebral discs were stabilized in the patients, the replacement segment and range of motion of whole cervical spine were respectively (14.2± 5.6)° and (33.8±10.3)°, there was no significant differences between preoperative and postoperative (P>0.05). Spinal cord sagittal diameter was increased from preoperative (5.2±1.3) mm to postoperative (8.8±0.5) mm (P<0.05).</p><p><b>CONCLUSION</b>Anterior cervical Hybrid surgery with posterior longitudinal ligament retained can achieve fully decompression and good clinical efficacy, we recommend retaining the normal posterior longitudinal ligament in surgery as complete as possible.</p>