Shim Chan Shik, Lee Sang-Ho, Park Hyun-Ju, Kang Han-Sug, Hwang Ji-Hee
Department of Neurosurgery, Wooridul Spine Hospital, Gangnam-Gu, Seoul, Korea.
J Spinal Disord Tech. 2006 Oct;19(7):465-70. doi: 10.1097/01.bsd.0000211235.76093.6b.
Among 61 patients underwent disc replacement with the Bryan prosthesis, 47 patients were followed more than 3 months and their clinical and radiologic data were retrospectively analyzed to clarify very early clinical and radiologic outcomes and complications of disc arthroplasty with the Bryan Cervical Disc prosthesis during the learning period. Mean follow-up period was 6 months. Mean age was 45.6 years. Single-level procedure was done in 39 patients and 2-level in 8; a total of 55 levels replaced. Neck disability index improved from 59.8% to 22.9%. Visual analog pain score (VAS) of the neck improved from 8.4 to 1.6. VAS of shoulder/arm pain improved from 8.8 to 2.4. Mean patients' subjective improvement rate of symptoms was 71.1%. According to improvement in the neck disability index and VAS (over 50% improvement rate in each parameter), patients' subjective improvement rate (over 50%), and patients' satisfaction, the surgical success was achieved in 39 patients (83%). Eight patients (17%) showed failure. Mean segmental angle became more kyphotic after surgery from -0.7 degree of kyphosis (-11 to 7.7 degrees) to -1.3 degrees (-32 to 20.9 degrees) without statistical significance (P=0.55). Among 24 segments that showed preoperative kyphosis, 13 (54.2%) showed aggravated kyphosis, 7 (29.1%) showed decreased kyphosis and 4 (16.7%) recovered to lordosis. Among 31 segments that showed preoperative lordosis, 19 (61.3%) showed loss of lordosis and 12 (38.7%) showed increased lordosis. Mean range of motion increased significantly after surgery (6.7 to 8.5 degrees, P=0.04). Preoperative and postoperative segmental kyphosis was not related to clinical success. Cervical arthroplasty with the Bryan Cervical Disc prosthesis failed to restore segmental lordotic angle. A concern arises because it is well known that the fusion in kyphotic curvature causes more frequent problems on adjacent levels in anterior cervical discectomy and fusion. For the present, it seems preferable to exclude the patient who already has significant segmental kyphosis from disc arthroplasty with Bryan Cervical Disc prosthesis.
在61例行Bryan假体椎间盘置换术的患者中，47例患者随访时间超过3个月，对其临床和影像学资料进行回顾性分析，以明确在学习阶段使用Bryan颈椎间盘假体进行椎间盘置换术的早期临床和影像学结果及并发症。平均随访时间为6个月。平均年龄为45.6岁。39例行单节段手术，8例行双节段手术；共置换55个节段。颈部功能障碍指数从59.8%改善至22.9%。颈部视觉模拟疼痛评分（VAS）从8.4降至1.6。肩部/手臂疼痛的VAS从8.8降至2.4。患者主观症状改善率平均为71.1%。根据颈部功能障碍指数和VAS的改善情况（各参数改善率超过50%）、患者主观改善率（超过50%）以及患者满意度，39例患者（83%）手术成功。8例患者（17%）手术失败。术后平均节段角度后凸加重，从术前的后凸0.7度（-11至7.7度）变为-1.3度（-32至20.9度），差异无统计学意义（P = 0.55）。在术前存在后凸的24个节段中，13个（54.2%）后凸加重，7个（29.1%）后凸减轻，4个（16.7%）恢复为前凸。在术前存在前凸的31个节段中，19个（61.3%）前凸丢失，12个（38.7%）前凸增加。术后平均活动范围显著增加（6.7至8.5度，P = 0.04）。术前和术后节段后凸与临床成功无关。使用Bryan颈椎间盘假体进行颈椎置换术未能恢复节段前凸角度。令人担忧的是，众所周知，颈椎前路椎间盘切除融合术中后凸融合在相邻节段引起的问题更为频繁。目前，对于使用Bryan颈椎间盘假体进行椎间盘置换术而言，似乎最好排除已经存在明显节段后凸的患者。
