Bin Sheng, Xiangwang Huang, Sheng Xiao, Tiecheng Xiang, Xiangyang Liu, Yi Zhang, Bin Liu
Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, P.R. China.
Clin Spine Surg. 2017 Jun;30(5):E587-E591. doi: 10.1097/BSD.0000000000000173.
Retrospective study.
To evaluate the outcome of artificial cervical disk replacement (ACDR) for the treatment of adjacent segment disease (ASD) after anterior cervical decompression and fusion (ACDF).
ACDF is the useful procedure for degenerative cervical diseases. However, studies have reported accelerated degeneration of functional spinal units adjacent to the fusion site after ACDF.
Between January 2004 and January 2011, 32 inpatients (18 male, 14 female; age, 38-61 y; mean, 48 y) underwent ACDR for the treatment of ASD after previous ACDF (single-level: n=12; 2-level: n=15; 3-level: n=5). In 22 patients, ASD occurred above the fusion site, and in 10 it occurred below the site. After ACDR, the patients were followed up for 30-62 months (mean, 49 mo). Before and after ACDR, patients were evaluated using the pain visual analog scale (VAS), the Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). In addition, the range of motion (ROM) of the replaced and adjacent unfused segments was measured by flexion/extension lateral radiography. Periprosthetic heterotopic ossification was detected using McAfee's classification. Degeneration of the adjacent unfused segment was evaluated using Goffin scale.
All patients had successful surgery. Before ACDR, neck VAS, upper-limb VAS, JOA score, and NDI were 7.2±1.8, 6.9±1.1, 9.8±2.5, and 40.5±4.8, respectively. At the last follow-up, they were 1.2±0.3, 0.9±0.3, 14.5±1.1, and 9.0±2.5, respectively. Compared with presurgery, the improvements in VAS, JOA score, and NDI at the final follow-up were statistically significant (all P<0.05). During follow-up, prosthesis positioning was satisfactory without migration or downward movement. Preoperatively, the ROMs of the replaced and adjacent segments were 8.7±2.6 and 7.6±3.0, respectively. At the last follow-up, they were 8.5±2.2 and 7.2±2.6, respectively (both P>0.05). At the last follow-up, 2 patients had grade II heterotopic ossification; 3 patients had aggravated degeneration (vs. preoperative status) of the adjacent unfused segment. However, the reduction in Goffin grade was not statistically significant.
Our follow-up shows that ACDR is an effective treatment for post-ACDF ASD. It can maintain the ROMs of the replaced segment as well as the adjacent unfused segment.
回顾性研究。
评估人工颈椎间盘置换术（ACDR）治疗颈椎前路减压融合术（ACDF）后相邻节段疾病（ASD）的疗效。
ACDF是治疗退行性颈椎疾病的有效方法。然而，研究报道ACDF后融合部位相邻功能脊柱单元加速退变。
2004年1月至2011年1月，32例住院患者（男18例，女14例；年龄38 - 61岁，平均48岁）因既往ACDF术后ASD接受ACDR治疗（单节段：n = 12；双节段：n = 15；三节段：n = 5）。22例患者ASD发生在融合部位上方，10例发生在下方。ACDR术后，对患者进行30 - 62个月（平均49个月）的随访。ACDR前后，采用疼痛视觉模拟量表（VAS）、日本骨科协会（JOA）评分和颈部功能障碍指数（NDI）对患者进行评估。此外，通过屈伸位侧位X线片测量置换节段和相邻未融合节段的活动度（ROM）。采用McAfee分类法检测假体周围异位骨化。使用Goffin量表评估相邻未融合节段的退变情况。
所有患者手术均成功。ACDR术前，颈部VAS、上肢VAS、JOA评分和NDI分别为7.2±1.8、6.9±1.1、9.8±2.5和40.5±4.8。末次随访时，分别为1.2±0.3、0.9±0.3、14.5±1.1和9.0±2.5。与术前相比，末次随访时VAS、JOA评分和NDI的改善具有统计学意义（均P<0.05）。随访期间，假体位置满意，无移位或下沉。术前，置换节段和相邻节段的ROM分别为8.7±2.6和7.6±3.0。末次随访时，分别为8.5±2.2和7.2±2.6（均P>0.05）。末次随访时，2例患者发生Ⅱ级异位骨化；3例患者相邻未融合节段退变加重（与术前相比）。然而，Goffin分级的降低无统计学意义。
我们的随访表明，ACDR是治疗ACDF术后ASD的有效方法。它可以维持置换节段以及相邻未融合节段的ROM。
