Wigfield Crispin C, Gill Steven S, Nelson Richard J, Metcalf Newton H, Robertson James T
Department of Neurosurgery, The Academic Centre, Frenchay Hospital, Bristol, United Kingdom.
Spine (Phila Pa 1976). 2002 Nov 15;27(22):2446-52. doi: 10.1097/00007632-200211150-00006.
A clinical prospective observational cohort study of 15 patients undergoing cervical intervertebral disc replacement.
To assess the safety, clinical stability, and capacity of a newly designed cervical intervertebral disc replacement for preserving motion in the cervical spine of patients with degenerative disc disease.
Anterior cervical discectomy and interbody fusion results in loss of motion segments and there is evidence of accelerated degenerative changes occurring at adjacent levels. Intervertebral disc replacement may be a valid alternative to fusion. There is a need for cervical disc replacement to be evaluated in prospective studies before it can be adopted as an acceptable surgical technique.
The study enrolled 15 patients with cervical radiculopathy or myelopathy and radiologically confirmed cervical disc herniation or posterior vertebral body osteophytes. Eligibility for the study required that patients have either a previous adjacent-level surgical or congenital spinal fusion or radiologic evidence of adjacent-level degenerative disc disease. After decompressive surgery via an anterior approach, all 15 patients received the artificial joint. Follow-up visits were at set intervals and included clinical examination, radiologic assessment, and evaluation by patient-completed questionnaires.
In all cases, the artificial joint maintained motion at the operative levels while reestablishing intervertebral height. The procedure was considered safe for experienced spine surgeons to perform, and the device was stable, with no dislocation of components or backing out of screws. Two screws broke, but without any consequence. Improvements in assessment scores were noted.
Cervical intervertebral motion can be maintained with the new device, which is clinically stable. Meticulous attention must be paid to the surgical technique to maximize the chances of a good result. The pilot study was successful, although it has yet to be determined what conditions will benefit most from this technology.
一项对15例接受颈椎间盘置换术患者的临床前瞻性观察队列研究。
评估一种新设计的颈椎间盘置换术在退行性椎间盘疾病患者颈椎中保留运动功能的安全性、临床稳定性及能力。
颈椎前路椎间盘切除及椎间融合术会导致运动节段丧失，且有证据表明相邻节段会加速发生退变改变。椎间盘置换术可能是融合术的一种有效替代方法。在颈椎间盘置换术被采纳为可接受的外科技术之前，有必要在前瞻性研究中对其进行评估。
该研究纳入了15例患有神经根型颈椎病或脊髓型颈椎病且经影像学证实存在颈椎间盘突出或椎体后缘骨赘的患者。研究的入选标准要求患者既往有相邻节段手术史或先天性脊柱融合术史，或有相邻节段退行性椎间盘疾病的影像学证据。经前路减压手术后，所有15例患者均接受了人工关节置换。定期进行随访，包括临床检查、影像学评估以及患者填写问卷进行评价。
在所有病例中，人工关节在手术节段维持了运动功能，同时恢复了椎间高度。该手术对于有经验的脊柱外科医生来说被认为是安全的，并且该装置稳定，没有部件脱位或螺钉松动。有两枚螺钉断裂，但未造成任何后果。评估评分有所改善。
新装置可维持颈椎的运动功能，且临床稳定。必须密切关注手术技术以最大程度提高取得良好效果的机会。尽管尚未确定哪些情况将最受益于这项技术，但初步研究是成功的。
