Dave Bharat, Chauhan Vikrant, Amin Prarthan, Mayi Shivanand, Krishnan Ajay, Degulmadi Devanand, Rai Ravi Ranjan, Dave Mirant, Bali Shiv Kumar, Charde Pranav, Anil Abhijith
Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
J Craniovertebr Junction Spine. 2023 Jul-Sep;14(3):268-273. doi: 10.4103/jcvjs.jcvjs_56_23. Epub 2023 Sep 18.
Cervical disc arthroplasty (CDA) was developed for the treatment of cervical disc disease with the potential advantages of preservation of physiological motion at a discal level, thereby potentially reducing adjacent level stresses and degeneration, which were a known complication of anterior cervical arthrodesis. The objective of this study was the assessment of long-term functional and radiological outcomes overtime in all the patients who underwent CDA from 2011 to 2019 at our institute.
Forty-eight patients who underwent CDA (2011-2019) with a minimum 2-year follow-up were retrospectively evaluated. The functional outcome included the Visual Analog Score (VAS) and Neck Disability Index (NDI). Radiographs were assessed for range of motion (ROM) at the index surgical level, presence of heterotopic ossification (HO), and adjacent segment degeneration.
The mean follow-up was 5.79 ± 2.96 (2.16-11.75) years. Significant improvement ( < 0.05) was observed in the VAS (8.91 ± 2.52 [preoperative] to 0.89 ± 1.27 [follow-up]) and NDI (65.5% ±23.06% [preoperative] to 4.79 ± 3.87 [follow-up]) score. Motion at index level increased significantly from 5.53° preoperatively to 7.47°, and 92% of the implanted segments were still mobile (referring to the threshold of ROM > 3°). HOs are responsible for the fusion of 4/50 (8%) levels at the last follow-up. Distal and proximal adjacent disc degeneration occurred in 36% and 28% of patients, respectively. No migration of the implant was observed on the radiograph.
Our study showed favorable clinical outcome of CDA with preservation of ROM at the index surgical level. CDA can be a promising alternative to anterior cervical arthrodesis when properly indicated.
颈椎间盘置换术(CDA)是为治疗颈椎间盘疾病而开发的,具有在椎间盘水平保留生理运动的潜在优势,从而有可能减少相邻节段的应力和退变,这是颈椎前路融合术已知的并发症。本研究的目的是评估2011年至2019年在我院接受CDA治疗的所有患者的长期功能和影像学结果。
回顾性评估48例2011年至2019年接受CDA且至少随访2年的患者。功能结果包括视觉模拟评分(VAS)和颈部功能障碍指数(NDI)。对X线片进行评估,以确定手术节段的活动范围(ROM)、异位骨化(HO)的存在以及相邻节段退变情况。
平均随访时间为5.79±2.96(2.16 - 11.75)年。VAS评分(术前8.91±2.52至随访时0.89±1.27)和NDI评分(术前65.5%±23.06%至随访时4.79±3.87)有显著改善(<0.05)。手术节段的活动度从术前的5.53°显著增加到7.47°,92%的植入节段仍可活动(指ROM>3°的阈值)。在最后一次随访时,HO导致4/50(8%)节段融合。分别有36%和28%的患者发生远端和近端相邻椎间盘退变。X线片上未观察到植入物移位。
我们的研究表明CDA具有良好的临床效果,且在手术节段保留了ROM。当适应证合适时,CDA可能是颈椎前路融合术的一个有前景的替代方法。