Medium-term Effects Of Anterior Fusion And Replacement Surgery Approach To The Treatment Of Cervical Spondylosis

Objective：Cervical disease (cervical spondylosis) refers to its secondarychanges due to cervical disc degeneration irritation or compression of adjacenttissue and cause a variety of symptoms and (or) signs of a disease. It is afrequently-occurring disease, common diseases, and incidence rates are risingyear by year. Fixation of anterior cervical decompression and fusion is theclassic surgical treatment of cervical disease, is widely used, and recentefficacy, but studies have found that in the medium and long term will beexposed to some of the problems at home and abroad, such as the bone blockprolapse bone graft healing, kyphosis and adjacent segment degeneration.Severe cases also need to be performed again surgery.Treatment of cervicaldisease not only to decompression, even the best reconstruction of the stabilityof the cervical spine, the stability of the environment within the mechanics arevery important.Recently, an exciting new technology-cervical artificial discreplacement surgery is turn out,which is able to maintain the activity of theoperative segments, delay the degenerative changes characteristic bright spots.Although appeared late，the new artificial disc have been developing fast andthe introduction of the Bryan artificial disc is gaining more and more supportand recognition.This paper aims to through retrospective analysis comparinganterior cervical decompression and fusion and internal fixation with theBryan cervical artificial disc replacement in the treatment of cervicalspondylosis interim efficacy.Method：A retrospective analysis methods, analysis the patients whoreceive integration or replacement surgery from March2005to January2011in our hospital, access to telephone or outpatient follow-up for at least24months of cervical spondylosis50cases, including29males and21femalescases; patients age50-79years old, with an average of57.2years;24-70 months of follow-up, an average of42.5months.Grouped according to thedifferent surgical methods; first group for anterior cervical decompressionfusion and internal fixation group (A), a total of34cases,22males and12females, aged50-79years old, average59.0years old; Bryan artificial discreplacement group (B) for the second group, a total of16cases, including7males and9females, aged50-63years old, with an average of53.3yearsold;Improvement were observed in patients with preoperative and final followup nerve function, preoperative and postoperative cervical anteroposterior andlateral X-ray and CT scan, and in some cases after camera MRI filmsobserved calculated fusion segment curvature changes in the activities of theupper and lower segments of the operative segments adjacent and cervicaltotal activity to assess the surgical outcome.Results: All patients were followed up for24-70months, with anaverage of42.5months. The clinical symptoms are alleviated, improvement inspinal cord function, and no serious complications. JOA score of the twogroups: Group: A preoperative JOA average score of8.91±1.33,thepostoperative discharge was11.24±1.54, at final follow up was15.03±1.57; BGroup: preoperative JOA average score of8.81±1.25, the postoperativedischarge was11.78±1.37, at final follow up was15.34±1.55. The JOA scoreis no significant difference between the two groups of patients after surgeryand final follow.Curvature of the change in the fusion segments: preoperativeof the A group kyphosis was11.76%(4/34), in group B patients with kyphosiswas12.50%(2/16), the difference was not statistically significant (P>0.05).Follow-up final group A patients with kyphosis was23.53%(8/34), group B12.50%(2/16), the difference was statistically significant (P <0.05), A groupof patients with kyphosis high incidence in the B group. Activities of theupper and lower segments of the operative segments adjacent areas:preoperative difference was not significant significance (P>0.05), thefollow-up replacement group was significantly less than the fusion group (P<0.05); replacement group surgery The the postoperative activity significantlyincreases the range of the adjacent segments before and after the difference was not statistically significant (P>0.05), the fusion group before and aftersurgery, the difference was statistically significant (P <0.05),.Replacementgroup up and down near the joint activity did not significantly increase; ofpostoperative fusion group and the replacement group activity significantdifference (P<0.05). Cervical total activity: group A preoperative ROM(48.7±14.3)°, follow-up of the end of the period as (45.6±11.8)°; B grouppreoperative ROM (47.6±13.8)°, follow-up of the end of the period as(44.3±13.1)°. ROM is not statistically significant (P>0.05) in Group A beforeand after surgery, Group B before and after surgery showed no statisticallysignificant (P>0.05). Preoperative compare the difference was not statisticallysignificant (P>0.05), the difference was not statistically significant (P>0.05)in the final follow up.Conclusions: Bryan cervical artificial disc replacement and anteriorcervical decompression and fusion and internal fixation can be effective toimprove the clinical symptoms, restore nerve function. Cervical artificial discreplacement surgery compared with the latter also able to maintain the activityof the of postoperative surgical segment of the upper and lower adjacentsegments, avoid adjacent segment compensatory activities and the restorationof cervical lordosis, to maintain cervical curvature and other advantages, has agood value and development prospects, this group of patients achieved asatisfactory interim efficacy.