| Background: From the point of view of its meaning, Cervical Spondylosis should be defined as those relevent clinical signs and symtomps from kinds of cercial segemental disease. Currently, the well recognized definition refers to the cervical spondylosis is as follows: the corresponding signs and symptoms caused by the lesions or damage of cervical spinal cord, spinal nerves, blood vessesls due to the degenerative cervical intervertebral disc diseases, and its related secondary intervertebral joint degeneration. Due to the clinical manifestations of the cervical spondylosis is varied, so its classification method also is not the same, but the four basic types recognized by scholars. They are cervical spondylosis myelopathy, cervical spondylosis radiculopathy, sympathetic cervical spondylosis, and vertebral artery type of cervical spondylosis. Among them, cervical spondylosis myelopathy accounted for about 10% of the cervical spondylosis, mainly due to the spinal cord and or spinal nerves compression from the nucleus pulposus, marginal osteophyte of vertebral body,proliferous hypertrophy of yellow ligament calcification of longitudinal ligament. Usually the main complaint was not neck pain, but were limbs weakness, instability of walking and handling. With the progress of the development the disease, it can present irreversible nerve damage, mainly show as motor neuron damage. Cervical spondylosis myelopathy should be treated surgically when it is clearly diagnosed in principle. Anterior cervical discectomy,decompression, bone graft fusion and internal fixation(Anterior cervical discectomy and fusion, ACDF) has been carried out in clinical for many years, which is still considered as the gold standard for cerivcal spondylosis treatment by most scholars and spine surgeon. At present, in the clinical application of the most popular ACDF surgery is intervertebral fusion(Cage) combined anterior Plate(Plate) to complete fixation and intervertebral fusion.But long-term follow-up found that this way especially due to the placement of the front plate appear a series of related complications, such as dysphagia, tracheoesophageal damage,displacement of steel plate, Cage subsidence and adjacent segment degeneration acceleration and other issues.More than it is to avoid complications and save located road fixed the advantage of intervertebral bone graft fusion, Zero-P intervertebral fusion arises at the historic moment.But in terms of clinical efficacy, there have been more studies show that nosignificant differences, both cervical spondylosis patients postoperative rehabilitation is still a problem to be solved.And the effect of acupuncture in the field of rehabilitation of traditional Chinese medicine is also more and more get the attention of people and apparent.Has yet to see the application of traditional acupuncture and modern new Zero-P to treat myelopathic type was reported to improve the clinical curative effect of cervical spondylosis.Objective: 1. To evaluate the clinical curative effect of Zero-P and acupuncture for the treatment of myelopathic type cervical vertebra disease clinical curative; 2. To evaluate the postoperative complications after the two kinds of interial fixation system, mainly focus on the dysphagia; 3. To evaluate the advantages and disadvantages of the method of adding acupuncture to both kinds of interal fixation system compared with the traditional types.Methods Fourty patients diagnosed as cervical spondylosis myelopathy treated with one or two seement(s) ACDF were enrolled in this study in the First and Second Hospital of Jilin University since December 2012 to April 2014. Among them, there were 25 males(62.5%)and 15 females(37.5%), 52.6 years old on average(range, 33 ~ 73 years). Medical history 26.4months(range, 6 months to 5 years). 20 cases were treated with the traditional intervertebral cage and anterior Plate internal fixation system(Cage + Plate Group, CPG), the Zero-P system were applied for the other 20 cases(Zero-P Group, ZPG). Then, the two groups were randomly futher divided into tow sub-groups which had 10 people each group. One group were applied with the routine postoperative rehabilitation, the other group were applied with the combined method of acupuncture plus routine rehabilitation. Therefore, there were four groups finally: pure Cage + Plate Group(CP), Cage + Plate combined Acupuncture treatment Group(Cage + Plate plus Acupuncture Group, CPA), Zero-P Group(ZP), Zero-P combined Acupuncture treatment Group(Zero-P plus Acupuncture Group, ZPA). All patients were followed up for one year. Operation time, intraoperative blood loss, preoperative and postoperative JOA, NDI, BYDS and postoperative complications were record and analysed.Results: operation time: CP group : 81.0±25.7min, ZP group : 52.5±21.0min,intraoperative blood loss:CP group:87.3±34.0ml,ZP group:29.3±13.5ml. Postoperative complications: CP group: 2 cases swallowing difficult, BYDS assessment are for in the moderate degrees, 1 cases cerebrospinal fluid leak, treated by prevention infection, and reset tube decompression, and pressurized close suture successfully; CPA group: 1 casesswallowing difficult, BYDS assessment are for in the moderate degrees, ZP group: appeared 1cases cerebrospinal fluid leak; ZPA group: no clear postoperative complications; application Cage+Plate system and Zero-P system treatment spinal cord type cervical disease between,Neurological Assessment index JOA and NDI no significant differences were found, but acupuncture therapy combined with acupuncture to treat less group VAS improvements better than acupuncture group and improved sooner.Conclusion In this study, all patients with cervical spondylosis myelopathy treated with both two internal fixation has obtained the good clinical curative effect. Application of Zero-P system have less operation time, intraoperative blood loss, lower incidence of postoperatie dysphagia compared with Cage + Plate system. Cage+Plate system and the Zero-P system for the treatment of cervical spondylosis myelopathy, no significant differences of neurological assessment index such as JOA and NDI were found. However the treatment combining acupuncture do offer better recover of JOA, NDI, and VAS and improved sooner. Zero-P system in the treatment of cervical spondylotic myelopathy can reduce the duration of surgery and trauma, combined with acupuncture for patients after surgery improve neurological function and pain relief... |
