Ma Yukun, Xiong Yang, Wang Ting, Yu Xing, Li Chuanhong, Meng Letian, Zhao He, Yang Yongdong, Zhao Dingyan, Wang Fengxian, Qu Yi
Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing, 100700, China.
Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, No.5 Warehouse, Dongcheng District, Beijing, 100700, China.
J Orthop Surg Res. 2024 Dec 19;19(1):857. doi: 10.1186/s13018-024-05316-4.
To examine the mid-term efficacy and imaging results of using the Mobi-C and Bryan implants after cervical hybrid surgery for 2-level cervical spondylolisthesis, and to observe their postoperative changes and differences in the flexion-extension center of rotation (FE-COR) for the anterior cervical disc replacement (ACDR) segment.
Patients who underwent cervical hybrid surgery between June 2014 and June 2019 were included in this study. The mJOA, NDI, and VAS scores were used to assess clinical outcomes, and the FE-COR of the ACDR segment was measured. Pre-operative and 36-month radiographs were collected to compare the range of motion (ROM) in the total cervical spine, ACDR segmental ROM, and operated adjacent segmental ROM. Translation distances for the Mobi-C and Bryan devices were measured. The degree of disc degeneration in the adjacent segment and bony fusion of the ACDF segment were observed.
Eighty-one patients were included (40 in the Mobi-C group and 41 in the Bryan group). All patients showed improvements in their postoperative mJOA, NDI, and VAS scores (P < 0.05). The C2-C7 ROM decreased in both groups (P < 0.05). There was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with preoperatively (P > 0.05). No significant differences were found between the two groups in the above ROM measurements (P > 0.05). For the Mobi-C group, the follow-up compared with pre-surgery showed statistical significance in both FE-COR-X (44.86 ± 7.70% vs. 57.13 ± 8.45%, P < 0.05) and FE-COR-Y (52.29 ± 12.71% vs. 34.47 ± 10.32%, P < 0.05). For the Bryan group, there were no significant differences at follow-up in FE-COR-X and FE-COR-Y compared with pre-surgery (P > 0.05). No significant difference in translation distance between the two groups was observed (P > 0.05). All ACDF segments were in a stable condition. Twenty-two out of 162 adjacent segments showed imaging ASD (9 cases in the Mobi-C group and 13 cases in the Bryan group). In the Mobi-C group, there were mild cases in 6 instances and moderate cases in 3 instances. In the Bryan group, there were mild cases in 8 instances and moderate cases in 5 instances.
Cervical hybrid surgery using either the Mobi-C or Bryan artificial cervical discs can achieve satisfactory results. The FE-COR of the Mobi-C segment shifts forward and downward, while the FE-COR of the Bryan segment is relatively closer to the pre-operative condition. Changes in the FE-COR after hybrid surgery in both the Mobi-C and Bryan segments might not affect clinical outcomes.
探讨在二级颈椎滑脱的颈椎混合手术后使用Mobi-C和Bryan人工椎间盘的中期疗效及影像学结果，并观察其术后变化以及颈椎前路椎间盘置换（ACDR）节段屈伸旋转中心（FE-COR）的差异。
本研究纳入2014年6月至2019年6月期间接受颈椎混合手术的患者。采用改良日本骨科学会（mJOA）评分、颈部残疾指数（NDI）和视觉模拟评分（VAS）评估临床疗效，并测量ACDR节段的FE-COR。收集术前和术后36个月的X线片，比较颈椎总活动度（ROM）、ACDR节段ROM和手术相邻节段ROM。测量Mobi-C和Bryan装置的平移距离。观察相邻节段椎间盘退变程度和ACDF节段的骨融合情况。
共纳入81例患者（Mobi-C组40例，Bryan组41例）。所有患者术后mJOA、NDI和VAS评分均有改善（P < 0.05）。两组患者C2-C7的ROM均降低（P < 0.05）。与术前相比，ACDR节段ROM以及上、下相邻节段ROM均无显著降低（P > 0.05）。两组在上述ROM测量方面无显著差异（P > 0.05）。Mobi-C组随访时与术前相比，FE-COR-X（44.86 ± 7.70% vs. 57.13 ± 8.45%，P < 0.05）和FE-COR-Y（52.29 ± 12.71% vs. 34.47 ± 10.32%，P < 0.05）均有统计学意义。Bryan组随访时FE-COR-X和FE-COR-Y与术前相比无显著差异（P > 0.05）。两组平移距离无显著差异（P > 0.05）。所有ACDF节段均处于稳定状态。162个相邻节段中有22个出现影像学相邻节段退变（ASD）（Mobi-C组9例，Bryan组13例）。Mobi-C组中，轻度6例，中度3例。Bryan组中，轻度8例，中度5例。
使用Mobi-C或Bryan人工颈椎间盘进行颈椎混合手术均可取得满意效果。Mobi-C节段的FE-COR向前下方移位，而Bryan节段的FE-COR相对更接近术前状态。Mobi-C和Bryan节段混合手术后FE-COR的变化可能不影响临床疗效。
