| Study Purposes: Anterior cervical disc decompression and fusion(ACDF)is one of the standard techniques of surgical operation for clinical treatment of cervical spondylosis while posterolateral decompression in combination with bone infusion and internal fixation can provide the stability of cervical vertebrae.The clinical symptoms are obviously alleviated post-operationally and the therapeutic effects are significant.However,the surgery segments loss the motional function due to the infusion and fixation.The compensatory activities of the adjacent upper-and the lower-segments are increased and the tension of cervical vertebrae is altered.This can cause the problems,i.e.some complications such as acceleration of degeneration of the adjacent segments occur,which affects the long-term therapeutic outcomes of ACDF.Artificial cervical disc replacement(CDR)is a newly emerging cervical vertebrae non-infusion technique,which implants the artificial interlocking cervical prosthesis with similar anatomy structure into the intervertebral space lesions,so that the height of the intervertebral space of displaced segment and the cervical range of motion can be reserved and there are no significant changes in cervical mechanics and are close to the physiological state.There are no significant influences on tension of the adjacent upperand lower-segments and thus,theoretically,can slow down the degeneration of the adjacent segments.Since CDR was applied clinically,a large number of clinical studies have been reported,which have indicated that clinical outcomes of CRD are quite significant.However,there is still a quite large debate in term of its protection of the degeneration of the adjacent segments.In this study,by applying the retrospective study method,we compared the clinical and therapeutic outcomes between CDR that utilizes Discover prosthesis and ACDF to find out the difference between them in protection of the adjacent segments and to obtain the theoretical guiding for providing the reference for clinical selection of surgical operation mode.Data and Methods 1.The patients who were given CDR surgical operation in this department during the period from January 2010 to January 2013 were statistically analyzed and recruited in this study based on both inclusion and exclusion criteria.A total of 44 cases of patients were recruited into this study.The recruited patients were all implanted with artificial Discover cervical intervertebral disc.Among them,26 cases were males and 18 cases were females with the ages ranging from 32-63 years old and the mean age of 47.37±8.07 years old.Cervical spondylotic myelopathy was classified into 28 cases,and nerve root type was found in 16 cases,44 cases were singled segment and there were no double segments.There were a total of 44 segments.Among them,one case was C3-4,5 cases were C4-5,28 cases were C5-6 and 10 cases were C6-7.The preoperative Kellgren X-ray of cervical degeneration in grade 0 and 41 cases,2 cases of grade 1,grade 2 in 1 cases,0 cases of grade 3,grade 4 in 0 cases,degeneration rate is 6.8%.2.The patients who were given ACDF surgical operation in this department during the period from January 2010 to January 2013 were statistically analyzed and recruited in this study based on both inclusion and exclusion criteria.A total of 61 cases of patients were recruited.The fixed materials for the recruited patients were all Zephir anterior steel plate,which were all obtained from the autologous transplantation ilium.Among them,37 cases were males,24 cases were females with the ages ranging from 34-73 years old and mean age of 50.07±8.67 years old.Cervical spondylotic myelopathy was classified into 36 cases,and nerve root type was found in 25 cases,Two cases were double segments,and 63 cases were singled segment.Among them,one case was C3-4,8 cases were C4-5,43 cases were C5-6 and 11 cases were C6-7.The preoperative Kellgren X-ray of cervical degeneration in grade 0 and 56 cases,3 cases of grade 1,grade 2 in 2 cases,0 cases of grade 3,grade 4 in 0 cases,degeneration rate is 7.5%.3.Two groups of patients with gender,age,disease type and surgical segment and preoperative JOA score,VAS score,NDI score,adjacent segments of the preoperative difference of Kellgren X-ray of cervical degeneration grading and occurrence rate were not statistically significant(P>0.05),The two groups were comparable.4.SPSS19.0 statistical software was used to conduct statistical analysis.The follow-up visits to patients of two groups were conducted.The JOA score,VAS score and NDI Score and the motion range of adjacent upper-and lower-segments were recorded at each time point of the follow-up visit and paired sample t-test was applied to compare.The status of adjacent segment degeneration was evaluated with Rank sum test.The comparison between two groups was performed with independent sample t-test.The rating status of adjacent segment vertical interspace disc degeneration was compared with Rank sum test.The test level α=0.05.Results: Two groups of patients were followed up,the average follow-up time was 42 months,No hematoma and infection were seen in the cut sites of the patients in two groups and the cut sites were sealed in phase I and no any other surgical operation-related complications occurred.In the ACDF group,there was one case of patient who had intervertebral disc degeneration and protrusion,which caused pain in hind neck and the radiating pain in left upper extremity.The patient was given CDR surgical operation,these symptoms were alleviated.After surgical operation,the implants were not dislocated,loosen and the internal fixation was not fractured.1.For 44 cases of patients who were given CDR surgical operation,the post operational JOA score was significantly increased as compared to that before surgical operation.The nerve functions were significantly improved(P<0.001).The nerve functions 9.45±1.80 prior operation to 13.41±1.0 in follow-up post operation.VAS and NDI scores at various follow up time points post operation were significantly improved as compared to that before surgical operation(P<0.001).At the last follow-up,there was a significant change in the activity of the adjacent upper-and lower-segments(P<0.05).The Kellgren X-ray cervical vertebrae degeneration rating in the last follow-up were as follows: 39 cases: 0 grade;2 cases: 1 grade;2 cases: 2 grade,1 case: 3 grade;and 0 cases: 4 grade,The incidence of degeneration was 11.3%,and the difference was statistically significant(Z=2.121 P=0.034).2.For 61 cases of patients who were given ACDF operation,the post operational JOA score was significantly increased as compared to that before surgical operation.The nerve functions were significantly improved(P<0.001).The JOA score was increased from 10.01±1.45 before operation to 13.92±0.86 in the last follow-up.The VAS and NDI scores at various time points after operation were all significantly increased as compared to that before operation.At the last follow-up,there was a significant change in the activity of the adjacent upper-and lower-segments(P<0.05).The Kellgren X-ray cervical vertebrae degeneration rating in the last follow-up were as follows: 43 cases: 0 grade;14 cases: 1 grade;3 cases: 2 grade;3 cases: 1 grade;and 0 case: 4 grade,The incidence of degeneration was 29.5%,and the difference was statistically significant(P<0.001).3.Comparison between two groups at the same time points of follow-up: there were no statistically significant differences in JOA score,NDI score at any time points of follow up(P>0.05).In the last follow up,There was no statistically significant difference in the range of motion of the adjacent upper-and lower-segments between the last follow up and before operation(P>0.05).At the last follow-up,the incidence of CDR group was 11.3%,the incidence rate of ACDF group was 29.5%,There was significant difference in the Kellgren X-ray cervical vertebrae degeneration rating between the last follow-up and before operation(Z=2.070 P=0.036).Conclusions: Artificial Cervical disc replacement(CDR)can provide good medium-term and long-term therapeutic outcomes for the treatment of cervical spondylosis.Analysis of adjacent segment degeneration after operation,CDR can protect the adjacent segments and slow down the adjacent segment degeneration. |
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