Analysis and prediction of related factors of single-level cervical total disc replacement / 中国组织工程研究

ABSTRACT

BACKGROUND: There is limited anterior cervical spine space. Incomplete hemostasis or drainage during artificial cervical total disc replacement can incur a series of complications. Preoperative factors can directly affect the amount of bleeding during spine surgery, while there are no publications aiming at cervical artificial disc replacement. OBJECTIVE: To analyze influencing factors on operation time and hemorrhage in patients undergoing single cervical total disc replacement. METHODS: Fifty-six patients with cervical spondylosis who underwent cervical total disc replacement from October 2012 to December 2017 in Department of Spine Surgery, Peking University People’s Hospital, were retrospectively enrolled. Pre- and intra-operative related parameters were measured. Primary outcomes included operation time, intraoperative blood loss and postoperative drainage. The secondary outcomes included demographic data such as sex, male and hypertension; surgery-related information such as operated segment, types of cervical spondylosis and artificial prosthesis; parameters in X-ray plain films such as the motion range and cervical lordosis of C2-C7 and index segment, the height of intervertebral disc, MRI classification (Modic classification and Pfirrmann classification) and preoperative functional score. The analysis was performed between primary and secondary outcomes as well as among primary outcomes. RESULTS AND CONCLUSION: (1) The average age of 56 patients (30 males and 26 females) was 48.2±9.8 years; operation time, intraoperative bleeding and postoperative drainage were 73.2±13.4 minutes, 51.8±41.2 mL and 7.8±5.3 mL, respectively. (2) There were no differences both in operation time and intraoperative blood loss in terms of demographics, while the drainage was statistically different in various ages (P=0.030). (3) The operation time of Prestige-LP implantation was statistically shorter than that of Mobi-C and Prodisc-C (P < 0.05). There was a positive correlation between the intermittent on taking (nonsteroidal anti-inflammatory drugs) and intraoperative blood loss (r=0.310, P=0.020). The higher intervertebral disc of the operation segment was, the longer operation time was (P=0.028). (4) There was a significant difference in more intraoperative blood loss with osteoporosis compared to the normal ones (P=0.039); while the rest radiological parameters in X-ray were in no relation to primary outcomes, neither were in MRI degree, Modic change and Pfirrmann classification. (5) There was a positive correlation between operation time and intraoperative blood loss (P=0.010) and postoperative drainage (P=0.001). (6) These indicate that the height of intervertebral space can prolong operation time. Osteoporosis is a risk factor for intraoperative blood loss. The longer the operation time is, the more intraoperative blood loss and postoperative drainage will be.