Lei Tao, Liu Yaming, Wang Hui, Xu Jiaxin, Ma Qinghua, Wang Linfeng, Shen Yong
From the Department of Spine Surgery, and The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Spine Surgery, Third Hospital of HeBei Medical University, 139 Ziqiang Rd, Shijiazhuang, Hebei Province, 050051, China.
Int Orthop. 2016 Jun;40(6):1197-203. doi: 10.1007/s00264-015-3098-7. Epub 2016 Jan 7.
Bryan cervical disc arthroplasty has been reported with satisfactory short- and medium-term clinical results. However, the long-term clinical and radiographic outcomes are seldom reported. The purpose of this study was to compare the eight-year follow-up results in patients who underwent Bryan disc arthroplasty with patients received ACDF, and assess the incidence of heterotopic ossification (HO) and its effect on clinical outcome and mobility of the device.
Thirty-one patients underwent Bryan disc arthroplasty, and 35 patients underwent ACDF were included in the study. The Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), visual analogue scale (VAS) of neck and arm pain, and the radiographs were used to evaluate the outcomes. The heterotopic ossification (HO) was determined by CT scan and was classified into three subgroups to compare the related effect. Adjacent segment degeneration (ASD) was also observed.
At final follow-up, there were no significant differences in JOA scores between two groups, but the improvement in NDI and neck or arm VAS were significantly greater in the Bryan disc cohort. The range of motion at the index level was 7.0° in Bryan group, while 100 % bone fusion were achieved in ACDF group. HO was observed in 18 (51.4 %) levels. There were more restricted movement of the prosthesis and slight higher rate of axial pain in patients with severe-HO (grade III and IV). Fourteen (28.6 %) levels developed ASD in Bryan group, which was significantly lower than that (58.6 %) in ACDF group.
At eight year follow-up, the clinical and radiographic outcomes of Bryan cervical disc arthroplasty compared favorably to those of ACDF. It avoided accelerated adjacent segment degeneration by preserving motion. However, severe HO restricted the ROM of the index levels and maybe associated with post-operative axial pain.
据报道，Bryan颈椎间盘置换术的短期和中期临床效果令人满意。然而，长期的临床和影像学结果鲜有报道。本研究的目的是比较接受Bryan椎间盘置换术的患者与接受ACDF（前路颈椎间盘融合术）的患者的八年随访结果，并评估异位骨化（HO）的发生率及其对临床结果和假体活动度的影响。
本研究纳入了31例行Bryan椎间盘置换术的患者和35例行ACDF的患者。采用日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）、颈部和手臂疼痛的视觉模拟量表（VAS）以及影像学检查来评估结果。通过CT扫描确定异位骨化（HO），并将其分为三个亚组以比较相关影响。还观察了相邻节段退变（ASD）情况。
在末次随访时，两组间JOA评分无显著差异，但Bryan椎间盘置换组的NDI改善以及颈部或手臂VAS改善显著更大。Bryan组手术节段的活动范围为7.0°，而ACDF组实现了100%的骨融合。在18个节段（51.4%）观察到HO。重度HO（III级和IV级）患者的假体活动受限更多，轴向疼痛发生率略高。Bryan组有14个节段（28.6%）发生ASD，显著低于ACDF组（58.6%）。
在八年随访时，Bryan颈椎间盘置换术的临床和影像学结果优于ACDF。它通过保留活动度避免了相邻节段退变加速。然而，重度HO限制了手术节段的活动范围，可能与术后轴向疼痛有关。
