Song Q P, Tian W, He D, Han X, Zhang N, Wang J C, Li Z C
Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing 100035, China.
Zhonghua Yi Xue Za Zhi. 2018 May 8;98(17):1358-1363. doi: 10.3760/cma.j.issn.0376-2491.2018.17.015.
To evaluate the long-term efficacy of cervical artificial disc replacement for patients with cervical disc herniation and degenerative cervical canal stenosis. Total of sixty-eight patients underwent single-level Bryan artificial disc replacement in Beijing Jishuitan Hospital from December 2003 to December 2007 with a minimum 10-year follow-up were retrospectively analyzed. There were 43 males and 25 females with a mean age of (46±8) years. According to preoperative CT and MRI, the patients were divided into two groups: 27 patients in cervical disc herniation group and 41 patients in degenerative cervical canal stenosis group. The evaluation indexes before surgery and at last follow-up were compared between two groups. The clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom's grade; and the radiological indexes included the global and segmental range of motion (ROM), Cobb's angle at operated level. The continuous variable data were analyzed by independent sample test. In cervical disc herniation group, the improvement rate of JOA score was 83%±22%, NDI% decreased by 14%±9%, and Odom's grade was excellent in 17 patients, good in 10 patients. In degenerative cervical canal stenosis group, the improvement rate of JOA was 68%±34%, NDI% decreased by 11%±7%, and Odom's grade was excellent in 19 patients, good in 18 patients, fair in 4 patients. The segmental ROM was 10°±4° and 7°±6° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (=2.284, =0.026). The global ROM was 50°±9° and 44°±14° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (=2.112, =0.038). Cervical artificial disc replacement has a favorable long-term efficacy in treating cervical degenerative diseases. The postoperative global and segmental ROM in patients with cervical disc herniation are better than those in patients with degenerative cervical canal stenosis.
评估颈椎人工椎间盘置换术治疗颈椎间盘突出症和退变性颈椎管狭窄症患者的长期疗效。回顾性分析2003年12月至2007年12月在北京积水潭医院接受单节段Bryan人工椎间盘置换术且至少随访10年的68例患者。其中男性43例,女性25例,平均年龄(46±8)岁。根据术前CT和MRI,将患者分为两组:颈椎间盘突出症组27例,退变性颈椎管狭窄症组41例。比较两组术前及末次随访时的评估指标。临床指标包括日本骨科协会(JOA)评分、颈部功能障碍指数(NDI)和奥多姆分级;影像学指标包括整体和节段活动度(ROM)、手术节段的Cobb角。连续变量数据采用独立样本检验分析。颈椎间盘突出症组JOA评分改善率为83%±22%,NDI%下降14%±9%,奥多姆分级优17例,良10例。退变性颈椎管狭窄症组JOA改善率为68%±34%,NDI%下降11%±7%,奥多姆分级优19例,良18例,可4例。末次随访时颈椎间盘突出症组和退变性颈椎管狭窄症组的节段ROM分别为10°±4°和7°±6°(t=2.284,P=0.026)。末次随访时颈椎间盘突出症组和退变性颈椎管狭窄症组的整体ROM分别为50°±9°和44°±14°(t=2.112,P=0.038)。颈椎人工椎间盘置换术治疗颈椎退变性疾病具有良好的长期疗效。颈椎间盘突出症患者术后的整体和节段ROM优于退变性颈椎管狭窄症患者。