A Medium To Long-term Evaluation Of Curative Effect And Imaging After Treatment Of Cervical Spondylosis With Cervical Artificial Disc Replacement

Objective:1. To evaluate the medium to long-term curative effect of CADR.2. Observe themidium to long-term imaging change character of CADR.3. Evaluate the main advantageand insufficient of CADR, draw lessons for the next clinic job.Methods:1. Collecte all the CS patients’ data from march2004to march2007(over5yearsafter operation) in the First Affiliated Hospital of Nanhua University, of which there are20patients’ data are complete and to accept CADR with single segment Bryan disc prosthesis.All these20cases were followed up, with period of60~92months (average78months)andreplacement segment C3/41case, C4/53cases，C5/615cases，C6/71case. All the patientsreceive JOA score, to evaluate neuron function progression and calculate the progressionratio. During the following up, all cases were received Odom’s classification to evaluatecurative effect, and calculate the excellent ratio of the operation.2. During operation andfollowing up, all cases were received X-ray examination of anterioposterior and lateral film,dynamic film of cervical vertebra, and MRI scan was carried on at the sametime. At theX-ray film, we observe the stability of cervical semment, and measured the cervicalcurvature, the cervical range of moving, the range of adjacent segment moving. During thefollowing up, we observe the Bryan disc prosthesis’s location, HO around the prosthesis atX-ray film. During operation and following up, the nearby disc’s degenerationclassification（Pfirrmann classification）, disc height and vertebral canal’s sagittal diameter.3. All the imaging indexs are calculated with PACS system at my hospital, and repeate for three times to get the average value. We use SPSS17.0software to caompare and analysisstatistically all these data with pair t test (α=0.05，P<0.05).Results:1. The JOA score is8.8±0.9(before-op) and15.2±1.0(follow-up). The value is thechange ratio is78﹪. During following the Odom’s classification is excellence9case, good8cases, average2cases, poor1case, the excellent curative effect rate is85%.2. Druingthe operation and following, all the cervical semments don’t show instability, however,during following, all Bryan disc prosthesis don’t show movement. During following theHO around the prosthesis was noted in6(30﹪) segments, with classⅠ1case, classⅡ1case, classⅢ3case, classⅣ1case. The cervical curvature increase to normal value withbefore operation4.7±3.7mm, following6.0±3.5mm, the difference is significantstatistically. The cervical range of moving is43.7±11.9°before operation,45.1±14.4°during following; the range of upper adjacent segment moving is9.7±1.8°before operation,10.0±1.6°during following; the range of lower adjacent segment moving is10.8±2.4°before operation,10.9±2.3°during following; all these data haven’t difference betweenbefore operation and following.3. The disc height and vertebral canal’s sagittal diameter ofupper adjacent segment don’t have difference statistically. The disc height of loweradjacent segment is8.36±0.54mm before operation, and7.90±0.87mm during following,the difference value is0.46±0.51mm(P=0.001). The vertebral canal’s sagittal diameter oflower adjacent segment is11.79±0.83mm,11.19±0.91mm during following, the differencevalue is0.59±0.66mm(P=0.002). When comparing before and following operation, the6discs ‘protrude of6different patient exaggerate class one, of which4disc height of4casereduce over5﹪, of which3disc height of3case reduce over5﹪.4. The ratio of ASD is15﹪(6/40case) during following, of which one case (5﹪,1/20case) adjacent segmentdisease is noted, without cure effect after conservative treatment. Conclusion:1.All cases of CADR with the Bryan disc prosthesis have been followed up foraverage6.5years, all these cases have good neuron function improvement, and the cliniccure is good.2.After following6.5years, all the Bryan cervical disc prosthesis keep good location,the stability of cervical segment is good. The cervical curvature increase to normal value,the cervical range of moving and the range of adjacent segment moving both keep good,and the ratio of HO around the prosthesis is high.3.After following6.5years, the ratio of ASD after CADR with the Bryan discprosthesis is lower, of which one case is adjacent segment disease. The lower adjacentsegment degeneration’s ratio is superior than the upper adjacent segment.