Department of Neurosurgery, Naval Medical Center San Diego, California 92134, USA.
Neurosurg Focus. 2010 May;28(5):E18. doi: 10.3171/2010.1.FOCUS102.
The introduction of cervical and lumbar arthroplasty has allowed for management of cervical radiculopathy and lumbar degenerative disease in patients with the preservation of motion at the affected segment. While the early clinical outcomes of this technology appear promising, it remains unclear what activity limitations should be imposed after surgery in patients with these implants. This is of particular interest in military personnel, who may be required to return to a rigorous level of activity after surgery. The goals of the FDA trials evaluating various disc arthroplasty devices were to establish safety, efficacy, and equivalency to arthrodesis. Information regarding the level of physical performance attained and restrictions or limitations is lacking, as these were outside the objectives of these trials. Nevertheless, there data are essential for the military surgeon, who is tasked with guiding the postoperative management of patients treated with arthroplasty and returning them to full duty. While there is a single report of clinical results of lumbar arthroplasty in athletes, at this writing, there are no reports of either cervical or lumbar arthroplasty in active duty military personnel.
The surgical database at a single, tertiary care military treatment facility was queried for all active-duty patients who underwent placement of either a cervical or lumbar arthroplasty device over a 3-year period. The authors performed a retrospective chart review to collect patient and procedural data including blood loss, length of hospital stay, tobacco use, age, rank, complications, and ability to return to full unrestricted active duty. Arthroplasty cohorts were then compared to historical controls of arthrodesis to ascertain differences in the time required to return to full duty.
Twelve patients were identified who underwent cervical arthroplasty. All patients returned to unrestricted full duty. This cohort was then compared with 12 patients who had undergone a single-level anterior cervical discectomy and fusion. The average time to return to unrestricted full duty for the arthroplasty group was 10.3 weeks (range 7-13 weeks), whereas that in the fusion group was 16.5 weeks. This difference between these 2 groups was statistically significant (p = 0.008). Twelve patients were identified who underwent lumbar arthroplasty. Ten (83%) of 12 patients in this group returned to unrestricted full duty. In patients who returned to full duty, it took an average of 22.6 weeks (range 12-29 weeks). This cohort was then compared with one in which patients had undergone anterior lumbar interbody fusion. Eight (67%) of 12 patients in the lumbar arthrodesis group returned to unrestricted full duty. In patients who returned to full duty, it took an average of 32.4 weeks (range 25-41 weeks). This difference was not statistically significant (p = 0.156).
The preliminary experience with cervical and lumbar arthroplasty at the authors' institution indicates that arthroplasty is comparable with arthrodesis and may actually expedite return to active duty. Patients are capable of returning to a high level of rigorous training and physical performance. There are no apparent restrictions or limitations that are required after 3 months in the cervical patient and after 6 months in the lumbar patient. Further prospective studies with long-term follow-up are indicated and will be of value when determining the role of arthroplasty compared to arthrodesis in the active-duty population.
颈椎和腰椎关节置换术的引入允许在保留受影响节段运动的情况下，对患有颈椎神经根病和腰椎退行性疾病的患者进行治疗。虽然该技术的早期临床结果似乎很有希望，但仍不清楚在这些植入物的患者手术后应施加哪些活动限制。这在军事人员中尤为重要，他们可能需要在手术后恢复到严格的活动水平。评估各种椎间盘关节置换设备的 FDA 试验的目标是确立安全性、有效性和与融合术的等效性。关于所获得的身体表现水平以及限制或限制的信息缺乏，因为这些都不在这些试验的目标范围内。然而，这些数据对于军事外科医生来说是必不可少的，他们的任务是指导接受关节置换术治疗的患者的术后管理，并使他们恢复全勤。虽然有一份关于运动员腰椎关节置换术的临床结果的报告，但截至撰写本文时，尚无关于现役军人颈椎或腰椎关节置换术的报告。
对一家单一的三级军事治疗机构的手术数据库进行了查询，以查找所有在 3 年内接受颈椎或腰椎关节置换术的现役患者。作者进行了回顾性图表审查，以收集患者和手术数据，包括失血量、住院时间、吸烟情况、年龄、职级、并发症以及恢复全无障碍现役的能力。然后将关节置换组与融合术的历史对照组进行比较，以确定恢复全勤所需的时间差异。
确定了 12 名接受颈椎关节置换术的患者。所有患者均恢复到不受限制的全勤。然后，将这组患者与 12 名接受单节段前路颈椎间盘切除术和融合术的患者进行比较。关节置换组恢复到不受限制的全勤时间平均为 10.3 周（7-13 周），而融合组为 16.5 周。这两组之间的差异具有统计学意义（p=0.008）。确定了 12 名接受腰椎关节置换术的患者。在这组患者中，有 10 名（83%）患者恢复到不受限制的全勤。在恢复全勤的患者中，平均需要 22.6 周（12-29 周）。然后，将这组患者与接受前路腰椎椎间融合术的患者进行比较。在融合术组中，有 8 名（67%）患者恢复到不受限制的全勤。在恢复全勤的患者中，平均需要 32.4 周（25-41 周）。这两组之间的差异无统计学意义（p=0.156）。
作者所在机构的颈椎和腰椎关节置换术的初步经验表明，关节置换术与融合术相当，实际上可能会加快恢复现役的速度。患者能够恢复到高强度的严格训练和身体表现水平。在颈椎患者中，3 个月后，在腰椎患者中，6 个月后，不需要任何明显的限制或限制。需要进一步进行前瞻性研究和长期随访，这将有助于确定关节置换术与现役人群中的融合术相比的作用。
