Neurosurgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Neurosurg Focus. 2010 May;28(5):E19. doi: 10.3171/2010.1.FOCUS1031.
In this study, the authors review the technique for inserting the Prestige ST in a contiguous multilevel cervical disc arthroplasty in patients with radiculopathy and myelopathy. They describe the preoperative planning, surgical technique, and their experience with 10 patients receiving a contiguous Prestige ST implant. They present contiguous multilevel cervical arthroplasty as an alternative to multilevel arthrodesis.
After institutional board review approval was obtained, the authors performed a retrospective review of all contiguous multilevel cervical disc arthroplasties with the Prestige ST artificial disc between August 2007 and November 2009 at a single institution by a single surgeon. Clinical criteria included patients who had undergone a multilevel cervical disc arthroplasty performed for radiculopathy and myelopathy without the presence of a previous cervical fusion. Between August 2007 and November 2009, 119 patients underwent cervical arthroplasty. Of the 119 patients, 31 received a Hybrid construct (total disc resection [TDR]-anterior cervical decompression and fusion [ACDF] or TDR-ACDF-TDR) and 24 received a multilevel cervical arthroplasty. The multilevel cervical arthroplasty group consisted of 14 noncontiguous and 10 contiguous implants. This paper examines patients who received contiguous Prestige ST implants.
Ten men with an average age of 45 years (range 25-61 years) were treated. Five patients presented with myelopathy, 3 presented with radiculopathy, and 2 presented with myeloradiculopathy. Twenty-two 6 x 16-mm Prestige ST TDRs were implanted. Six patients received 2-level Prestige ST implants. Five patients received TDRs at C5-6 and C6-7, and 1 patient received TDRs at C3-4 and C4-5. One patient received a TDR at C3-4, C5-6, and C6-7 where C4-5 was a congenital block vertebra. Three patients (2 with 3-level disease and 1 with 4-level disease) received contiguous Prestige ST implants as well as a Prevail ACDF as part of their constructs. The mean clinical and radiographic follow-up was 12 months. There has been no case of screw backout, implant dislodgment, progressive kyphosis, formation of heterotopic bone, evidence of pseudarthrosis at the Prevail levels, or development of symptomatic adjacent level disease.
Multilevel cervical arthroplasty with the Prestige ST is a safe and effective alternative to fusion for the management of cervical radiculopathy and myelopathy.
本研究中，作者回顾了在患有神经根病和脊髓病的患者中连续多节段颈椎间盘置换术（cervical disc arthroplasty）中置入 Prestige ST 的技术。作者描述了术前规划、手术技术以及对 10 例接受连续 Prestige ST 植入物的患者的经验。作者提出连续多节段颈椎关节置换术是多节段关节融合术的替代方法。
在获得机构委员会审查批准后，作者对 2007 年 8 月至 2009 年 11 月在单所机构由同一位外科医生进行的连续多节段颈椎间盘置换术（multilevel cervical disc arthroplasty）中的所有 Prestige ST 人工椎间盘进行了回顾性研究。临床标准包括接受多节段颈椎间盘置换术治疗神经根病和脊髓病的患者，且无先前的颈椎融合术。在 2007 年 8 月至 2009 年期间，119 例患者接受了颈椎关节置换术。在 119 例患者中，31 例接受了 Hybrid 构建物（total disc resection [TDR]-anterior cervical decompression and fusion [ACDF] 或 TDR-ACDF-TDR），24 例接受了多节段颈椎置换术。多节段颈椎置换术组包括 14 例非连续和 10 例连续植入物。本文研究了接受连续 Prestige ST 植入物的患者。
10 例平均年龄为 45 岁（25-61 岁）的男性患者接受了治疗。5 例患者表现为脊髓病，3 例患者表现为神经根病，2 例患者表现为脊髓神经根病。22 例 6 x 16-mm Prestige ST TDR 被植入。6 例患者接受了 2 级 Prestige ST 植入物。5 例患者接受了 C5-6 和 C6-7 的 Prestige ST 置换，1 例患者接受了 C3-4 和 C4-5 的 Prestige ST 置换。1 例患者在 C3-4、C5-6 和 C6-7 处接受了 Prestige ST 置换，而 C4-5 是先天性的阻挡椎体。3 例（2 例有 3 节段疾病，1 例有 4 节段疾病）接受了连续 Prestige ST 植入物和 Prevail ACDF，作为其构建物的一部分。平均临床和放射学随访时间为 12 个月。无螺钉退出、植入物移位、进行性后凸畸形、异位骨形成、Prevail 水平假关节形成或出现有症状的邻近节段疾病的病例。
多节段颈椎置换术（multilevel cervical disc arthroplasty）联合 Prestige ST 是治疗颈椎神经根病和脊髓病的一种安全有效的融合替代方法。
