| Objective: Multilevel cervical disease refers to the presence of multiplesegments of continuous or discontinuous cervical vertebrae in theradiographic edge osteoarthritis, osteophytes and disc degeneration, and otherprominent pathological changes, causing cervical spinal cord or hardmembrane sac in front of multiple planes of compression, and there is a classcorresponding clinical manifestations of cervical spondylosis.“Skip” cervicalspondylosis (SCS) refers to appear two or more segments of disc degenerationin imaging, as well as backward prominent vertebral osteophytes and otherpathological changes, resulting in a corresponding cervical spinal cord ornerve root segment, dural sac compression, and a corresponding clinicalmanifestations, there are more than one or a normal disc spacing betweenlesion segments. As a special type of multilevel cervical disease, surgicaltreatment for SCS, have less current literature and research. This study willshow a retrospective analysis and comparison about Bryan artificial cervicaldisc arthroplasty with anterior cervical decompression and fusion (ACDF) onthe clinical efficacy of the treatment for “Skip” cervical spondylosis.Method: From February2002-January2010,there were treated in ourdepartment and eventually completed the follow-up of patients with “Skip”cervical spondylosis49cases,29males and20females, were treated withBryan artificial cervical disc arthroplasty (artificial cervical disc replacementsurgery group,18cases) and anterior cervical decompression and fusion(ACDF group,31cases). Each case was evaluated on the moment inpreoperatively,3months,6and12months and last follow-up after surgery bythe Japanese Orthopedic Association (JOA),Neck Disability Index (NDI),Visual Analog Scale (VAS), Cervical sagittal curvature, the total cervical spine range of motion（ROM），middle segments of motion. And using MRIexamination to assess to adjacent segment disc degeneration and spinal cordcompression and signal change situation. And observed two groups of patientsoperative time, blood loss, operative costs. All patients were followed-up formore than24months， up to62months, the artificial cervical discarthroplasty group follow-up time was35.3±10.5months, ACDF group timewas36.4±10.1months.Results: Two groups of patients in the JOA score, NDI score, VAS scoreafter surgery than before surgery had significantly improved. JOA score ofartificial cervical disc arthroplasty group in preoperatively were6.7±1.7, inlast follow-up were15.9±0.8; and ACDF group were7.5±1.8, and16.0±1.5; NDI score of artificial cervical disc arthroplasty group in preoperativelywere43.1±3.7, in last follow-up were6.2±1.4; and ACDF group were41.5±3.8, and6.1±1.4; VAS score of artificial cervical disc arthroplasty group inpreoperatively were7.3±1.5, in last follow-up were1.6±0.8; and ACDFgroup were6.7±2.3, and2.7±1.2. In addition to the VAS score lastfollow-up were significantly different between the two groups outside (P=0.000), more than during the same set of data each time the node groupsshowed no significant difference.In last follow-up, the result of artificialcervical disc arthroplasty group were better than ACDF group on theincidence of axial symptoms, the total cervical spine range of motion (ROM),middle segments of motion. The incidence of axial symptoms in artificialcervical disc arthroplasty group were11.1%，but in ACDF group were45.2%.ROM in artificial cervical disc arthroplasty group were35.5±5.9°，but inACDF group were24.5±6.2°. Middle segments of motion in artificialcervical disc arthroplasty group were7.3±1.4°，but in ACDF group were10.1±1.6°. The above comparison of the data were statistically different.Artificial cervical disc arthroplasty group did not find significant adjacentsegment degeneration cases, but have no obvious advantage than ACDFpatients in the cost of surgery, operative time, blood loss. Fusion rate in ACDFgroup was100%, not finding in the last follow-up fixation failure syndromes such as pseudarthrosis or kyphosis occurs and so on. Two cases ofpostoperative ACDF patients approaching segment degeneration phenomenonwithout surgery.Conclusion: Regardless of Bryan artificial cervical disc replacementsurgery and anterior cervical decompression and fusion surgery of thetreatment for “Skip” cervical spondylosis can get a good neurologicalimprovement. So, the key of neurological rehabilitation is decompression,rather than using a different internal fixation. But Bryan artificial cervical discreplacement surgery effectively retained the overall motion of the cervicalspine, reducing the motion of middle segments, thus avoiding adjacentsegment degeneration and the incidence of postoperative axial symptoms.Bryan artificial cervical disc replacement surgery for “Skip” cervicalspondylosis has its great advantages. |
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