Comparative Study Of Clinical Efficacy And Complications Of Anterior Cervical Decompression And Fusion Vs Bryan Artificial Disc Replacement In The Treatment Of Cervical Spondylosis

Part 1 The study of cervical spine motor function and clinical effect after anterior cervical decompression and fusion vs Bryan artificial disc replacementObjective: To compare the mid-term follow-up clinical results and postoperative adjacent segment degeneration(ASD)occurrence of anterior cervical discectomy and fusion(ACDF)versus total cervical disc replacement(TDR)using the Bryan Cervical Disc Prosthesis in the treatment of cervical degenerative diseases.Method: A prospective comparative study of 93 patients who underwent ACDF or TDR for cervical degenerative disease were conducted.Of all the patients 57 were male and 36 female,mean age 48.6 years.According to the surgical approach,54 cases were classified into ACDF Group,39 cases into TDR Group.All patients were followed up for clinical results and imaging datas.The VAS score,JOA score,NDI score and imaging data(fusion rate,sagittal curvature,C2-7 activity,the upper intervertebral activity,the lower intervertebral activity)were assessed and compared before surgery,3 months,3 years,10 years after surgery.In the final follow-up the X-ray and the MRI were combined to evaluate the degeneration of the upper and the lower segements adjacent to the surgery segment..Results: A total of 68 patients(39 cases of ACDF Group and 29 cases of TDR Group)completed the final follow-up.There was no significant difference for ACDF group and TDR group at 3 days,3 months,3 years postoperately and the last follow-up in terms of JOA score,NDI score compared with preoperative scores.The last follow-up overall activity of the cervical replacement group had no significant difference from preoperative,meanwhile fusion group had decreased,but with no statistically significant difference.The preoperative C6/7 segmental activity in the replacement group was 9.5°±3.70°,and 7.0°±3.00°at 3 months postoperatively,6.6°±4.10°at the final follow-up.Compared with 3 months after surgery,the last follow-up had no significant change.We used lateral X-ray and MRI T2-weighted images to assess adjacent segment degeneration of all patients.The ASD cases was 19(48.72%)in the ACDF group,and 13(44.83%)in the TDR group.There was no statistically difference(P <0.05)in the two groups.Conclusion: Both ACDF group and TDR group have achieved good results for cervical degenerative diseases,there was no significant difference in the postoperative ASD rate in the two groups.Part 2 Influencing factors of adjacent segment degeneration after anterior cervical surgeryObjective:Based on long-term follow-up,this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration(ASD)after anterior cervical discectomy and fusion(ACDF)or total disc replacement(TDR)in treating cervical degenerative diseases.Method:Between January 2002 and December 2004,54 cases underwent ACDF and 39 underwent TDR,enrolled into this study.Every patient was followed up at least 10 years.29 cases in CADR group and 39 patients in ACDF group had completed the final follow-up with the whole imaging data.Outcome assessment included cervical lordosis,visual analogue scale(VAS)score,Neck Disability Index(NDI)score,Japanese Orthopaedic Association(JOA)score,and radiographic parameters.Results:19(48.72%)of 39 cases suffered from ASD in ACDF group,and13(44.83%)of 29 cases in TDR group.There was no statistical difference between the two groups regarding ASD incidence,VAS/NDI/JOA score,recovery rate.Logistic regression analysis showed that the regression equation was logit P=-4.09+0.05*X1-0.55*X3+0.41*X4(X1=age,OR=1.05,95%CI,1.03-1.07;X3 = preoperative overall lordosis,OR=0.57,95%CI,0.37-0.90;X4= preoperative segmental lordosis,OR=1.51,95%CI,1.09-2.30).Conclusion: Both ACDF and TDR group achieved satisfying therapeutic effect for cervical degenerative diseases.Advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD,while preoperative overall lordosis proves to be a protective factor.Part 3 The incidence and risk factors of dysphagia after single-level anterior cervical surgeryObjective:The aim of this study was to calculate the incidence of dysphagia and identify its potential risk factors.Method:We prospectively included the patients undergoing primary single-level anterior cervical spine surgery in our hospital and recorded specific perioperative data.The Bazaz grading system and the Swallowing Quality of Life(SWAL-QOL)score were used to assess the presence and severity of dysphagia.Correlations between the potential variables and postoperative dysphagia were investigated by analyzing data from 187 patients who finished more than 1-year follow-up.Results:The number of patients with dysphagia was 99(52.94%)at 1week after surgery,60(32.09%)at 1 month,42(22.46%)at 3 months,29(16.11%)at 6 months,and 16(8.56%)at 1 year.The preoperative mean SWAL-QOL score was 65.62,which decreased to 58.72 after surgery and to64.66 at the 12-month follow-up.The SWAL-QOL score at 1 week after surgery was correlated with the operative time(r =-0.474;P<0.001).Multivariate analysis showed that preoperative tracheal exercise(odds ratio(OR)= 0.302;95% confidence interval(CI)= 0.131–0.748),operative time <90 minutes(OR = 0.407;95% CI = 0.190–0.878),and arthroplasty(OR =0.211;95% CI = 0.102–0.425)were the independent factors associated with a lower incidence of postoperative dysphagia.Conclusion: our analysis described the natural course of dysphagia after surgery and demonstrated that tracheal exercise,short operative time,and arthroplasty were factors that may help to decrease the incidence of postoperative dysphagia.However,future prospective,randomized and controlled studies are needed to validate these findings.