Pointillart Vincent, Castelain Jean-Etienne, Coudert Pierre, Cawley Derek Thomas, Gille Olivier, Vital Jean-Marc
Department of Orthopaedic Surgery, Spine Unit 1, University Hospital Pellegrin, 33000, Bordeaux, France.
Int Orthop. 2018 Apr;42(4):851-857. doi: 10.1007/s00264-017-3745-2. Epub 2017 Dec 29.
The CTDR is a technique that treats cervical disc degenerative disease. Initial shorter-term studies showed good clinical and radiological results.
To assess the clinical and radiological results of Bryan cervical disc replacement (Medtronic Sofamor Danek Inc., Memphis, TN) at 15-year follow-up.
This prospective study included 20 patients who underwent 22 CTDR, comprising a single-level procedure in 14 patients and two-level procedures in six patients. The mean follow-up period was 15.5 years. The mean age at the intervention was 46.2 years (range: 26-65 years). Two patients needed re-operation for recurrence of symptoms. According to Odom's criteria, 80.0% (16 of 20 patients) had excellent outcomes, VAS for neck pain was 2.6 (0-10), for shoulder/arm pain it was 1.8 (0-7), and NDI at the final follow up was 14.9. The SF-12 PCS was 46.1, and SF-12 MCS was 51.9. Mobility was maintained in 15 of the 22 (68.2%) operated segments, range of motion (ROM) of prostheses were 9° ± 3.9° (range 4-15°). The prostheses were positioned in kyphosis in 14 of 22 levels (63.6%). There was a positive correlation between the kyphosis of the prosthesis and the occurrence of heterotopic ossification (HO), and their grade (ρ = 0.36, CI 95%[-0.68; 0.07]). HO had developed at 12 of the 22 levels (54.5%) and upper adjacent segment degeneration in 11 of 18 of patients (64.7%). All these results were not significantly different to outcomes at 8 years follow-up.
In a cohort of 20 patients with 15-year clinical and radiological follow-up, the Bryan CTDR has demonstrated a sustained clinical improvement and implant mobility over time, despite a moderate progression of degenerative processes at the prosthetic and adjacent levels.
颈椎间盘退变疾病经皮颈椎间盘置换术（CTDR）是一种治疗方法。最初的短期研究显示出良好的临床和影像学结果。
评估15年随访期内Bryan颈椎间盘置换术（美敦力索法玛·丹历公司，田纳西州孟菲斯）的临床和影像学结果。
这项前瞻性研究纳入了20例接受22次CTDR的患者，其中14例为单节段手术，6例为双节段手术。平均随访期为15.5年。干预时的平均年龄为46.2岁（范围：26 - 65岁）。2例患者因症状复发需要再次手术。根据奥多姆标准，80.0%（20例患者中的16例）预后良好，颈部疼痛视觉模拟评分（VAS）为2.6（0 - 10），肩部/手臂疼痛为1.8（0 - 7），末次随访时颈部功能障碍指数（NDI）为14.9。简明健康调查量表（SF - 12）的生理健康评分（PCS）为46.1，心理健康评分（MCS）为51.9。22个手术节段中的15个（68.2%）保持了活动度，假体的活动范围（ROM）为9°±3.9°（范围4 - 15°）。22个节段中的14个（63.6%）假体呈后凸位。假体后凸与异位骨化（HO）的发生及其分级之间存在正相关（ρ = 0.36，95%置信区间[-0.68; 0.07]）。22个节段中的12个（54.5%）发生了HO，18例患者中的11例（64.7%）出现了上位相邻节段退变。所有这些结果与8年随访时的结果无显著差异。
在一组进行了15年临床和影像学随访的20例患者中，尽管假体及相邻节段的退变过程有一定进展，但Bryan CTDR随时间推移显示出持续的临床改善和假体活动度。
