Liu Jinyang, Zhang Hongqi, Li Kanghua, Li Xiong
Department of Spinal Surgery, Xiangya Hospital of Central South University, Changsha Hunan, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr;23(4):385-8.
To investigate the clinical effect of cervical artificial disc replacement (CADR) on two-segment cervical spondylosis and to research its influences on the range of motion (ROM) of the diseased segments and the adjacent superior and inferior segments.
From September 2004 to February 2007, 7 cases with cervical spondylosis at C4,5 and C5,6 were treated with CADR using Bryan artificial disc prosthesis, including 4 males and 3 females aged 30-45 years old (average 38.5 years old). All the patients had cervicodynia in various degrees, pain and numbness of limbs and decreased muscle strength, including 3 cases of cervical spondylotic radiculopathy, 3 of cervical spondylotic myelopathy and 1 of mixed cervical spondylosis. The course of disease was 12-54 months (average 27 months). Preoperatively, X-ray films revealed the intervertebral space of C4,5 and C5,6 was narrowed and the cervical curve became straight, CT or MRI showed the intervertebral disk hernia of C4,5 and C5,6, and the hyperostosis of vertebral margin compressed nerve root or spinal cord. All the patients had no response to the preoperatively conservative treatment. JOA score and ROM of the diseased segments and the adjacent superior and inferior segments were compared before and after operation.
All the patients survived the perioperative period, without hoarse voice, muscle spasm, dysphagia and cervicodynia. X-ray films showed the implanted prosthesis was well located, the height of intervertebral space was normal, and no prosthesis loosening, prosthesis migration and infection occurred 12 months after operation. All the 7 cases were followed up for 12-41 months (average 26.7 months). Cervicodynia and limbs' pain and numbness disappeared, and muscle strength was improved obviously. The JOA score before and during the follow-up period was (8.35 +/- 1.27) and (14.65 +/- 1.61) points, respectively, indicating there was a significant difference (P < 0.05). For the ROM of C4,5 and C5,6, it was (8.38 +/- 0.48) degrees and (9.16 +/- 0.54) degrees before operation, respectively, and it increased to (11.15 +/- 0.65) degrees and (12.75 +/- 0.73) degrees after operation, respectively, showing there was a significant difference (P < 0.05). The ROM at C3,4 and C6,7 before operation was (9.71 +/- 0.76) degrees and (12.39 +/- 0.58) degrees, respectively, while it was improved to (10.26 +/- 0.47) degrees and (13.67 +/- 0.71) degrees after operation, respectively, indicating there were no significant differences between before and after operation (P > 0.05).
The application of Bryan Disc CADR for two-segment cervical spondylosis has satisfying therapeutic effects, can improve the ROM of diseased segments obviously, and has minor influences on the ROM of adjacent superior and inferior segment.
探讨颈椎人工椎间盘置换术（CADR）治疗两节段颈椎病的临床效果，以及对病变节段和相邻上、下节段活动度（ROM）的影响。
2004年9月至2007年2月，对7例C4、5和C5、6节段颈椎病患者采用Bryan人工椎间盘假体行CADR治疗，其中男4例，女3例，年龄30 - 45岁（平均38.5岁）。所有患者均有不同程度的颈痛、肢体疼痛麻木及肌力下降，其中神经根型颈椎病3例，脊髓型颈椎病3例，混合型颈椎病1例。病程12 - 54个月（平均27个月）。术前X线片显示C4、5和C5、6椎间隙变窄，颈椎生理曲度变直，CT或MRI显示C4、5和C5、6椎间盘突出，椎体边缘骨质增生压迫神经根或脊髓。所有患者术前保守治疗无效。比较手术前后病变节段及相邻上、下节段的日本骨科学会（JOA）评分和ROM。
所有患者围手术期均顺利，无声音嘶哑、肌肉痉挛、吞咽困难及颈痛。X线片显示植入假体位置良好，椎间隙高度正常，术后12个月无假体松动、移位及感染发生。7例患者均获随访，随访时间12 - 41个月（平均26.7个月）。颈痛及肢体疼痛麻木消失，肌力明显改善。随访期间JOA评分术前及术后分别为（8.35±1.27）分和（14.65±1.61）分，差异有统计学意义（P < 0.05）。C4、5和C5、6节段术前ROM分别为（8.38±0.48）°和（9.16±0.54）°，术后分别增至（11.15±0.65）°和（12.75±0.73）°，差异有统计学意义（P < 0.05）。C3、4和C6、7节段术前ROM分别为（9.71±0.76）°和（12.39±0.58）°，术后分别改善为（10.26±0.47）°和（13.67±0.71）°，差异无统计学意义（P > 0.05）。
Bryan人工椎间盘CADR应用于两节段颈椎病具有满意的治疗效果，能明显改善病变节段的ROM，对相邻上、下节段ROM影响较小。
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