Neurosurgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
J Neurosurg Spine. 2011 Jul;15(1):48-54. doi: 10.3171/2011.3.SPINE10385. Epub 2011 Apr 1.
Multilevel cervical arthroplasty achieved using the Prestige ST disc can be challenging and often unworkable. An alternative to this system is a hybrid technique composed of alternating total disc replacements (TDRs) and fusions. In the present study, the authors review the safety and radiological outcomes of cervical hybrid arthroplasty in which the Prestige ST disc is used in conjunction with 2 unique fusion techniques.
After obtaining institutional review board approval, the authors completed a retrospective review of all hybrid cervical constructs in which the Prestige ST disc was used between August 2007 and November 2009 at the Walter Reed Army Medical Center. A Prestige ST total disc replacement was performed in 119 patients. Thirty-one patients received a hybrid construct defined as a TDR and fusion (TDR-anterior cervical decompression and fusion [ACDF]) or as 2 TDRs separated by a fusion (TDR-ACDF-TDR). A resorbable plate and graft system (Mystique) or stand-alone interbody spacer (Prevail) was implanted at the fusion levels. Plain radiographs were compared and evaluated for cervical lordosis, range of motion, implant complications, development of adjacent-level disease, and pseudarthrosis. In addition, charts were reviewed for clinical complications related to the index surgery.
Thirty-one patients (18 men and 13 women; mean age 50 years, range 32-74 years) received a hybrid construct. All patients were diagnosed with radiculopathy and/or myelopathy. Twenty-four patients received a 2-level and 7 a 3-level hybrid construct. In 2 patients in whom a 2-level hybrid construct was implanted, a noncontiguous TDR was also performed. The mean clinical and radiological follow-up duration was 18 months. There was no significant difference in preoperative (19.3° ± 13.3°) and postoperative (19.7° ± 10.5°) cervical lordosis (p = 0.48), but there was a significant decrease in range in motion (from 50.0° ± 11.8° to 38.9° ± 12.7°) (p = 0.003). There were no instances of screw backout, implant dislodgement, progressive kyphosis, formation of heterotopic bone, pseudarthrosis, or symptomatic adjacent-level disease. Seven patients had dysphasia and 1 patient had vocal cord paralysis at 6 weeks. By 3 months, both the dysphasia and the vocal cord paralysis were resolved in all patients.
Hybrid cervical arthroplasty involving the placement of a Prestige ST disc and either the Mystique resorbable plate or Prevail stand-alone interbody device is a safe and effective alternative to multilevel fusion for the management of cervical radiculopathy and myelopathy.
使用 Prestige ST 椎间盘进行多节段颈椎关节置换术可能具有挑战性，且通常不可行。该系统的替代方法是一种由交替的全椎间盘置换术（TDR）和融合组成的混合技术。在本研究中，作者回顾了在 Walter Reed 陆军医疗中心，使用 Prestige ST 椎间盘的颈椎混合关节置换术的安全性和影像学结果，该中心使用了两种独特的融合技术。
获得机构审查委员会批准后，作者对 2007 年 8 月至 2009 年 11 月期间在 Walter Reed 陆军医疗中心使用 Prestige ST 椎间盘的所有混合颈椎结构进行了回顾性审查。119 例患者行 Prestige ST 全椎间盘置换术。31 例患者接受了混合结构治疗，定义为 TDR 和融合（TDR-颈椎前路减压融合术[ACDF]）或 2 个 TDR 之间的融合（TDR-ACDF-TDR）。融合水平植入了可吸收板和移植物系统（Mystique）或独立的椎间植入物（Prevail）。比较并评估颈椎前凸、活动范围、植入物并发症、邻近节段疾病的发展和假关节。此外，还回顾了与索引手术相关的临床并发症。
31 例患者（18 例男性和 13 例女性；平均年龄 50 岁，范围 32-74 岁）接受了混合结构治疗。所有患者均被诊断为神经根病和/或颈椎病。24 例患者接受了 2 节段和 7 例 3 节段的混合结构治疗。在接受 2 节段混合结构治疗的 2 例患者中，还进行了非连续 TDR。平均临床和影像学随访时间为 18 个月。术前（19.3°±13.3°）和术后（19.7°±10.5°）颈椎前凸无显著差异（p=0.48），但活动范围明显减小（从 50.0°±11.8°降至 38.9°±12.7°）（p=0.003）。没有螺钉退出、植入物移位、进行性后凸、异位骨形成、假关节或症状性邻近节段疾病的病例。7 例患者在 6 周时出现言语困难，1 例患者出现声带麻痹。3 个月时，所有患者的言语困难和声带麻痹均得到解决。
涉及 Prestige ST 椎间盘放置和 Mystique 可吸收板或 Prevail 独立椎间植入物的颈椎混合关节置换术是多节段融合治疗颈椎神经根病和颈椎病的一种安全有效的替代方法。
