Fay Li-Yu, Huang Wen-Cheng, Wu Jau-Ching, Chang Hsuan-Kan, Tsai Tzu-Yun, Ko Chin-Chu, Tu Tsung-Hsi, Wu Ching-Lan, Cheng Henrich
Department of Neurosurgery, Neurological Institute and.
J Neurosurg Spine. 2014 Sep;21(3):400-10. doi: 10.3171/2014.3.SPINE13387. Epub 2014 Jun 13.
Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM.
A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification .
Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24-56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p < 0.001). The mean operation time, mean estimated blood loss, and the percentage of patients prescribed perioperative analgesic agents were similar in both groups (p = 0.754, 0.652, and 0.113, respectively). There were significant improvements in VAS neck and arm pain, JOA scores, and NDI in both groups. Nurick scores in the myelopathy group also improved significantly after surgery. In radiographic evaluations, 92.5% of patients in the radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group.
The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.
颈椎关节置换术已被公认为是治疗颈椎病或退行性椎间盘疾病（DDD）的一种可行手术选择。颈椎关节置换术的最佳候选者是因椎间盘突出且小关节功能正常而患有神经根病的年轻患者。然而，对于由DDD引起的颈椎脊髓病患者，关节置换术是否同样有效仍不确定。本研究的目的是比较颈椎脊髓型颈椎病（CSM）患者和无CSM的神经根病患者的关节置换术结果。
本研究共纳入151例连续病例，这些患者因DDD导致CSM或神经根病，并接受了单节段或双节段颈椎关节置换术。回顾了临床结果评估和影像学研究。临床结果测量包括每位患者的颈部和手臂疼痛视觉模拟量表（VAS）、日本骨科协会（JOA）评分以及颈部功能障碍指数（NDI）。对于CSM患者，记录Nurick评分以评估颈椎脊髓病。影像学研究包括侧位动态X线片和CT，以检测异位骨化的形成。
在151例连续的颈椎DDD患者中，125例（82.8%；脊髓病组72例，神经根病组53例）至少有24个月的临床和影像学随访。这些患者的平均随访时间为36.4个月（范围24 - 56个月）。两组间性别分布无差异。然而，脊髓病组患者的平均年龄比神经根病组大约6岁（53.1岁对47.2岁，p < 0.001）。两组的平均手术时间、平均估计失血量以及接受围手术期镇痛药治疗的患者百分比相似（分别为p = 0.754、0.652和0.113）。两组的VAS颈部和手臂疼痛、JOA评分以及NDI均有显著改善。脊髓病组的Nurick评分在术后也显著改善。在影像学评估中，神经根病组92.5%的患者和脊髓病组95.8%的患者保留了脊柱活动度（无显著差异）。CT扫描评估显示，脊髓病组34例患者（47.2%）和神经根病组25例患者（47.1%）出现异位骨化（p = 0.995）。术后平均超过3年，两组均未报告二次手术情况。
由DDD引起的CSM患者在颈椎关节置换术后脊髓病的严重程度有所改善。在3年随访时，DDD合并CSM患者的颈椎关节置换术的临床和影像学结果与仅患有颈椎神经根病的患者相似。因此，对于因DDD导致CSM且需要前路手术的患者，颈椎关节置换术是一种可行的选择。然而，有必要与颈椎前路椎间盘切除融合术的标准手术治疗进行比较，以证实CSM关节置换术的结果。
