Rabin Doron, Pickett Gwynedd E, Bisnaire Lynn, Duggal Neil
Division of Neurosurgery, University of Western Ontario, London, Canada.
Neurosurgery. 2007 Sep;61(3 Suppl):100-4; discussion 104-5. doi: 10.1227/01.neu.0000289722.12459.9e.
Anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis may contribute to further degenerative changes at adjacent levels secondary to abnormal spinal motion. Insertion of a Bryan Cervical Disc (AD) (Medtronic Sofamor Danek, Memphis, TN) may prevent this accelerated degeneration. This retrospective study compares the in vivo x-ray cervical spine kinematics in patients with ACDF and AD.
Ten patients with single-level AD were matched to 10 patients with single-level ACDF based on age and sex. Lateral neutral, flexion and extension cervical x-rays were obtained preoperatively and at regular intervals up to 24 months postoperatively. Kinematic parameters, including range of motion, anteroposterior translation, and disc height, were assessed for all cervical functional spinal units using quantitative motion analysis software. Changes in these parameters were compared between matched patients from both groups using paired Student's t tests.
The range of motion at the operated level was greater in the AD group compared with the ACDF group at early (6.9 versus 0.89 degrees, P < 0.01) and late (8.4 versus 0.53 degrees, P < 0.01) follow-up evaluations. Translation was greater at the operated level in patients with AD at late follow-up (6.8 versus 0.8%, P < 0.03) evaluation. No significant between-group kinematic differences were seen at adjacent levels.
Patients with AD and those with ACDF demonstrated similar in vivo adjacent level kinematics within the first 24 months after anterior cervical decompression.
采用颈椎前路椎间盘切除融合术（ACDF）治疗颈椎病可能会因脊柱运动异常而导致相邻节段进一步发生退变改变。植入Bryan人工颈椎间盘（AD）（美敦力索法玛·丹纳克公司，田纳西州孟菲斯）可能会预防这种加速退变。本回顾性研究比较了接受ACDF和AD治疗患者的颈椎体内X线运动学情况。
根据年龄和性别，将10例单节段AD患者与10例单节段ACDF患者进行匹配。术前及术后定期（最长至术后24个月）拍摄颈椎中立位、前屈和后伸位的侧位X线片。使用定量运动分析软件评估所有颈椎功能脊柱单元的运动学参数，包括活动度、前后移位和椎间盘高度。采用配对t检验比较两组匹配患者这些参数的变化。
在早期（6.9°对0.89°，P<0.01）和晚期（8.4°对0.53°，P<0.01）随访评估中，AD组手术节段的活动度均大于ACDF组。在晚期随访评估中，AD患者手术节段的移位更大（6.8%对0.8%，P<0.03）。相邻节段未观察到显著的组间运动学差异。
在前路颈椎减压术后的前24个月内，AD患者和ACDF患者的体内相邻节段运动学情况相似。
