Chang Hsuan-Kan, Huang Wen-Cheng, Wu Jau-Ching, Tu Tsung-Hsi, Fay Li-Yu, Chang Peng-Yuan, Wu Ching-Lan, Chang Huang-Chou, Chen Yu-Chun, Cheng Henrich
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 508, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei, 11217, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
BMC Musculoskelet Disord. 2015 Aug 28;16:228. doi: 10.1186/s12891-015-0692-1.
The efficacy and safety of using cervical arthroplasty for degenerative disc disease have been demonstrated by prospective, randomized and controlled clinical trials. However, there are scant data on using cervical arthroplasty for traumatic disc herniation. Therefore, this study aimed to investigate the outcomes of patients who underwent cervical arthroplasty for traumatic disc herniation.
This cohort included patients who were admitted through the emergency department for trauma. Only patients who had newly-onset, one- or two-level cervical disc disease causing radiculopathy or myelopathy were identified. None of these patients had previously sought for medical attention for such problems. Those patients who had severe spinal cord injury (i.e. American Spinal Injury Association scale A, B or C) or severe myelopathy (i.e. Nurick scale 4 or 5), bony fracture, dislocation, perched facet, kyphotic deformity, or instability were also excluded. An age- and sex-matched one-to-one comparison was made between patients who underwent cervical arthroplasty, on the one hand, and anterior cervical discectomy and fusion (ACDF).
A total of 30 trauma patients (15 in the arthroplasty group and 15 in the ACDF group) were analyzed, with a mean follow-up of 29.6 months. The demographic data were similar. Post-operation, the arthroplasty group had significant improvement in VAS of neck and arm pain, JOA, and NDI when compared to their pre-operation status. Similarly, the ACDF group also improved significantly after the operation. There were no differences between the two groups in post-operative VAS neck and arm pain, and JOA scores. The arthroplasty group maintained a range of motion in the indexed levels and had better NDI scores at 6-months post-operation than the ACDF group.
For selected patients (i.e. no spinal cord injury, no fracture, and no instability) with traumatic cervical disc herniation, cervical arthroplasty yields similar improvement in clinical outcomes to ACDF and preserves segmental mobility.
前瞻性、随机对照临床试验已证实颈椎置换术治疗退行性椎间盘疾病的有效性和安全性。然而，关于颈椎置换术治疗创伤性椎间盘突出症的数据却很少。因此，本研究旨在调查接受颈椎置换术治疗创伤性椎间盘突出症患者的治疗结果。
该队列研究纳入了因创伤通过急诊科入院的患者。仅纳入新发的、导致神经根病或脊髓病的单节段或双节段颈椎间盘疾病患者。这些患者此前均未因此类问题寻求过医疗救治。同时排除那些患有严重脊髓损伤（即美国脊髓损伤协会分级为A、B或C级）或严重脊髓病（即努里克分级为4级或5级）、骨折、脱位、关节突交锁、后凸畸形或不稳定的患者。对接受颈椎置换术的患者与颈椎前路椎间盘切除融合术（ACDF）患者进行年龄和性别匹配的一对一比较。
共分析了30例创伤患者（置换术组15例，ACDF组15例），平均随访29.6个月。两组人口统计学数据相似。术后，置换术组与术前相比，颈部和手臂疼痛的视觉模拟评分（VAS）、日本骨科协会（JOA）评分和颈部功能障碍指数（NDI）均有显著改善。同样，ACDF组术后也有显著改善。两组术后颈部和手臂疼痛的VAS评分及JOA评分无差异。置换术组在术后6个月时，手术节段的活动度得以保留，且NDI评分优于ACDF组。
对于选定的创伤性颈椎间盘突出症患者（即无脊髓损伤、无骨折且无不稳定情况），颈椎置换术在临床疗效上与ACDF相似，且能保留节段活动度。
