Suigical Therapy And Prognostic Factor Analysis Of Cervical Spondylotic Radiculopathy

Objective:due to the neck cervical disc, cervical Luschka joint or facet joints hyperplasia, hypertrophy of bone spurs laterally prominent, irritation or compression of the appropriate level of nerve root, and there was a series of corresponding segment of nerve root irritation or dysfunction clinical manifestations. The clinical symptoms in the neck, shoulder, back pain, upper limbs and fingers radiating pain, numbness and weakness in the main. CSR is the more common kind of cervical disease. For cervical spondylotic radiculopathy, surgical treatment options and prognosis factors of limited information.Also controversial in some respects, the clinical understanding of its comprehensive enough, often ineffective surgery. Therefore, more research needs to be done. The main research cervical spondylotic radiculopathy caused by neck pain of anatomy and physiology, clinical characteristics, surgical treatment and analysis of the prognostic factors.Methods:1. A prospective study from Septemper 2012 to January 2014, Changzheng Hospital orthopedic admitted accepting anterior cervical decompression and fusion with internal fixation or artificial disc replacement therapy in patients with radicular cervical spondylosis 73. Male 30 and female 43 cases. A total of 73 patients were collected, depending on the surgical approach, divided into two groups namely artificial disc group of 35 patients (16 males,19 females), mean age 45.7 years (24-65),32 cases of a segment, the two sections three cases segment; average age interbody fusion group 38 patients (14 males,24 females) 46.5 years. The average follow-up of 1.4 years, the two groups were compared at the end of follow-up VAS (visual analogue scale), NDI (neck disability index), SF-36PCS, (PCS physiology section includes a front four dimensions (PF, RP, BP and GH); SF-36MCS MCS includes psychological part after four dimensions (RE, SF, MH and VT)) and surgery adjacent segment activity (ROM). Difference in efficacy studies comparing these two surgical treatment of cervical spondylotic radiculopathy and its effect on surgical activity adjacent segments2. A retrospective study in May 2012 to January 2015, Changzheng Hospital orthopedic admitted accept anterior decompression artificial disc replacement patients. Determine the cure group and non-cure groups based NDI score and after review. Analysis of factors affecting the surgical results:Background information, including:gender, age, duration of disease, smoking habits, EMG diagnosis, muscle, surgery segment, operative time, blood loss. Subjective variables:VAS (visual analogue scale), NDI (neck disability index). Analyze the prognostic factors provide the basis for clinical surgery designated.Results:1. After analysis, group of CTDR no significant difference in operative time and blood loss group of ACDF (the amount of bleeding CTDR group 184.9 ± 40.5ml, ACDF group 191.1±53.9ml, P>0.05, surgery CTDR group 144.5±14.0min, ACDF group 145.2 ± 15.1min, P>0.05). During the follow-up found no prosthesis and interbody fusion loose in displacements. Postoperative symptoms than before surgery significantly improved. Following conditions are met for the cure group:1, NDI score improved 15 points; 2, surgical nerve root segment feature is not persistent sexual dysfunction; 3, failed back surgery and the second surgery did not appear; 4, follow-up review of cervical lateral power bits and pieces about flexor X no artificial disc displacement, limited mobility and prosthesis-related problems. The remaining non-cured group.ACDF group CTDR group before surgery and the last with the VAS, NDI, SF-36PCS, SF-36-MCS showed no significant difference (P> 0.05); The final follow-up surgery ACDF group adjacent to the lower segment activity there are significant differences compared to preoperative (P<0.05); No significant difference between surgery and postoperative phase of the festival before CTDR group segment surgery, before surgery on the adjacent segment and lower segment activity and none want to compare surgery see significantly worse.2. Cured group of 34 people, not cured group of 11 people. By comparing the two sets of background information and subjective variables, age (p=0.012), duration (p=0.007), smoking habits (p=0.037), EMG confirmed (p=0.007), preoperative VAS (p<0.001), NDI (p<0.001) effect on postoperative recovery was statistically significant. Gender (p=0.045), surgical segments (p=0.260), cervical ROM (p=0.521), operative time (p=0.905) and bleeding (p=0.543) no significant difference on the prognosis.Conclusions:1. Artificial disc replacement group with anterior cervical decompression and fusion with internal fixation group were followed up for NDI score, VAS score, SF-36PCS score, SF-36MCS scores showed no significant difference. Artificial disc replacement surgery not only retains the segment motor function while reducing the influence of adjacent segments. This reflects that artificial disc replacement surgery in the treatment of nerve root type cervical disease is a feasible surgical approach.2. Preoperative younger, short duration, low NDI score, VAS score low, no smoking, decreased muscle strength nerve compression is less positive prognosis. Sex, surgical segment, segment surgery preoperative activity section, operative time, blood loss, such as no significant effect on the prognosis.