[Analysis of clinical effects of cervical artificial disc replacement or anterior cervical decompression and fusion for the treatment of single cervical disc herniation].

OBJECTIVE: To explore the clinical effects of Mobi-C cervical artificial disc replacement (CADR) and anterior cervical decompression and fusion (ACDF) in treating single cervical disc herniation. METHODS: From June 2009 to June 2012, the clinical data of 27 patients with single cervical disc herniation were retrospectively analyzed. There were 18 males and 9 females, aged from 30 to 62 years old with an average of 46.7 years. Of them, 12 patients were treated with CADR (CADR group) and 15 patients with ACDF (ACDF group). All patients had pain and numbness in neck, shoulder and upper limbs, and courses of disease was from 1 to 13 months with an average of 2.4 months. The data of clinical evaluation and questionnaire survey about quality of life were collected before operation, postoperative at 1 week and final follow-up. Odom criterion was used to evaluate postoperative effect. Visual analogue scale (VAS) was used to record pain levels. Neck disability index (NDI) and health questionnaire SF-36 were used to assess the quality of life. RESULTS: No complications about nerve and blood vessel were found and the patients were followed up from 6 to 30 months, with an average of 16 months. One week after operation, 10 cases got excellent results and 2 good in CADR group; 5 cases got excellent results and 10 good in ACDF group; there was significant difference between two groups (P<0.05). At final follow-up, 10 cases got excellent results and 2 good in CADR group; 12 cases got excellent results and 3 good in ACDF group; there was no significant difference between two groups (P> 0.05). Pain of upper limbs had obviously relieved between two groups at 1 week after operation and final follow-up (P<0.05). VAS of neck and NDI in CADR group had decreased respectively from preoperative 3.58±0.79, 23.42±6.36 to 0.58±0.51, 5.42±1.68 at 1 week after operation (P<0.05); but the index in ACDF group was no obvious at 1 week after operation. At final follow-up, VAS of neck and NDI and SF-36 score were obviously improved than preoperation (P<0.05) between two groups. CONCLUSION: Mobi-C CADR retains the movement unit in the decompression segment and can quickly recover normal action for patients. Using CADR method has a good curative effect in the early phase, and the clinical effect is reliable, may improve the quality of life.

[Preventive strategies of secondary spinal cord injury caused by subaxial cervical trauma].

OBJECTIVE: To summarize and analyze preventive strategies of secondary spinal cord injury caused by subaxial cervical trauma. METHODS: From April 2004 to April 2009, 67 patients with secondary spinal cord injury caused by subaxial cervical trauma were retrospectively analyzed. There were 40 males and 20 females, with an average age of 40.5 years old ranging from 18 to 69 years. After admission the preventive strategies included using MP and GM-1, early decompression, and high pressure oxygen after operation. The neurological function was classified by Frankel, and the therapeutic effect was evaluated by total recovery rate and useful recovery rate. The total recovery rate was that the level of Frankel raise one or more grade, the useful recovery rate which included Frankel D, E was that the patient can walk by self or crutch, remaining some neurological deficits. RESULTS: All patients were followed up for 1 to 3 years (averaged 1.5 years), the total recovery rate was 53.7% (36/67), the useful recovery rate was 35.8% (24/67). Seven patients was death, the death rate was 10.4% (7/67), 1 was aggravated, the aggravating rate was 1.5% (1/67). CONCLUSION: As possible as using MP, GM-1, early decompression, and high pressure oxygen after operation can be effective strategies for preventing secondary spinal cord injury caused by subaxial cervical trauma.

[Repair and re-establishment to traumatic upper cervical instability].

OBJECTIVE: To summarize and analyze the therapeutic effect of traumatic upper cervical instability and investigate therapeutic methods and effect. METHODS: There were 19 patients with traumatic upper cervical instability (male 16, female 3), aged from 21 to 56 years,included 3 cases of atlas fracture, 10 cases of dens fracture, 3 cases of axis pedicle fracture, 3 cases of atlanto-axial subluxation. Among them, 6 cases included 1 case of dens fracture, 1 case of dens fracture affiliated with atlas fracture, 1 case of axis pedicle fracture, 3 cases of atlanto-axial subluxation were treated conservatively and the other 13 cases were treated by operations. RESULTS: Nineteen cases were followed up for 1.8 years in average (6 months to 6 years). According to JOA standard for evaluation, the rate of improvement was 42.5% and 87.0% for conservative treatment and operation respectively. CONCLUSION: Traumatic super cervical unsteadiness should be diagnosed and treated early. Under the condition of upper cervical vertebra being completely fixed,the function of cervical vertebra to maximum extent could be reserved when choosing operation method. Especially, the precise fusion of upper cervical vertebra plays a vital role of long-term efficacy.