| BackgroundAnterior cervical discectomy and fusion (ACDF) was first introduced by Robinson and Smith in the1950s.It is an established surgical technique with successful clinical results for cervical degenerative disc disease and has become the gold standard with the development of surgical technique and internal fixation instrument.Through the research demonstrated by radiological studies,biomechanical and mathematical models, more and more scholars find the disadvantages of ACDF, such as accelerated degeneration of the adjacent segments and the abnormalities of cervical curvature, may lead to recurrence of symptoms or need for reoperation. As a new technology emergenced in the late20th century, artificial disc replacement (ADR) is designed to decrease the adjacent segment degeneration (ASD) by preserving the motion at the operative level. It is useful to analysis the clinical data of artificial disc replacement as well as anterior cervical discectomy and fusion. Compare the two surgical methods and observe the early clinical outcome of artificial disc replacement, which is important for evaluating the clinical value for cervical spondylosis.ObjectiveTo investigate the early clinical effects of cervical artificial disc replacement compared with anterior cervical discectomy and fusion, and analysis the clinical value of cervical artificial disc replacement.Methods75patients with cervical spondylosis treated at the first affiliated hospital of Zhengzhou university were included in a retrospective study between November2009and January2012.43patients (mean age50.2;25females and18males) underwent anterior cervical discectomy and fusion (ACDF group). There were22cases of cervical spondylotic myelopathy,16cases of cervical spondylotic radiculopathy and5cases of mixed cervical spondylosis involved. The operated segments were4cases of C3/4,26cases of C4/5,19cases of C5/6and3cases of C6/7. In contrast,39patients (mean age48.3;22females and17males) underwent artificial disc replacement (ADR group). There were21cases of cervical spondylotic myelopathy,12cases of cervical spondylotic radiculopathy and6cases of mixed cervical spondylosis involved. The operated segments were2cases of C3/4,20cases of C4/5,17cases of C5/6and2cases of C6/7. Clinical outcomes were evaluated by the Japanese Orthopedic Association Scale (JOA) and Odom’s Scale. The radiological evaluation included measurements of cervical curvature and the range of motion (ROM) at the adjacent segments. The data was analyzed by SPSS for windows15.0. Two-sample t-test was used to detect the difference among the two groups. Analysis of variance (ANOVA) was performed to detect difference in each group at different time. Pearson χ2test was used to detect difference in Odom’s Scale. The statistic significance was set at0.05.ResultsAll the patients were followed-up for average17.2months (3to26months). The JOA scores were all significantly improved in both group after surgery.3、6months and the final follow-up after operation, excellent or good Odom score outcomes were observed:90.7%、95.3%、93.1%of the patients in the ACDF group and92.3%、97.4%、97.4%of those in the ADR group respectively. In ACDF group, loss of cervical curvature indices after surgery was significantly greater than that before surgery and no obviously loss of cervical curvature was found in ADR group postoperatively. The adjacent ROM of the cases treated by ACDF increased obviously(P<0.05) after operation. In ADR group, the ROM of the adjacent segments had no significant change (P>0.05) at different time points after operation.Conclusion1. Both ACDF and ADR can achieve effective anterior decompression and show significant improvements in the clinical symptoms.2. Artificial disc replacement is a reliable method to maintain the cervical curvature and it does not significantly increase the ROM of the adjacent segments, which can effectively reduce the degeneration of cervical disc. The preliminary treatment effect of cervical spondylosis is satisfactory. |
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