The Clinical Study Of Cervical Artificial Disc Replacement For The Treatment Of Cervical Spondylotic Myelopathy

Objective: To evaluate the clinical efficacy of cervical artificial disc replacement for the treatment of Cervical Spondylotic Myelopathy by comparing the clinical efficacy of the two kinds of anterior spine surgery of cervical spondylosis in order to help clinician to kown more about cervical total disc replacement. Materials and Methods: 42 patients were definitely diagnosed as cervical spondylotic myelopathy with one-level or two-level disc degeneration, and among them 26 patients were treated by the anterior cervical decompression and fusion with plate, and 16 patients underwent cervical artificial disc replacement, among which 13 patients underwent one-level replacement and 3 patients underwent two-level replacement. A follow-up of all patients after operation was conducted, and the period was above 12 months. The clinical efficacy of the two kinds of anterior spine surgery of cervical spondylosis by JOA score and the change of the cervical spine biomechanics were analyzed, and the clinical efficacy was evaluated by the JOA score. Systemic radiographic study of the range of movement (ROM) of the replaced levels was measured, meantime the ROM of the adjacent levels of all case, the intervertebral height and the cervical biological curves were measured respectively. Results:1. The function of spinal cord was improved obviously without any complications, and the JOA score was improved obviously, too. There was no significant difference between the patients of the two groups in different periods.2. Replaced segment restored available ROM and obtained stability (5.10±0.48° and 6.32±0.46°, respectively).3. There was no visible disparation in the adjacent ROM of the cases treated by the cervical total disc replacement.4. The adjacent ROM of the cases treated by the anterior cervical decompression and fusion increased obviously. (1.60±0.48 mm vs. 1.83±0.36mm)5. The intervertebral height of the patients of the two groups both increased obviously after operation, but there was no visible disparation in the two groups pre-operation and post-operation.6. There was not significant difference between the two groups in the change of cervical biological curves of the patients after operation.Conclusions:1. The patients who underwent cervical artificial disc replacement obtained the same satisfactory clinical efficacy with those who underwent anterior cervical decompression and fusion.2. The patients treated with C-TDR obtained satisfactory improvement of the spinal cord function, restored available ROM in replacement segment and maintained the stability of the segment.3. After C-TDR, there were not any obvious changes in the adjacent ROM and cervical biological curves. The intervertebral height was restored, and the biomechanics of the cervical spine was maintained. Compared with ACDF, C-TDR achived good short-term clinical effect and it was safe and reliable. Because C-TDR maintained normal biomechanics, it may avoid or delay the adjacent segment degeneration.