Study On The Changes Of The Cervical Spine Sagittal Parameters After The Treatment Of Cervical Spondylosis With Traditional Chinese Medicine And Cervical Disc Replacement

Objective:To study the effect of fixed-point rotational reduction on the clinical efficacy of cervical spondylosis and the sagittal parameters of cervical vertebra imaging,and the changes of sagittal parameters of cervical vertebra imaging after cervical artificial disc replacement(cTDR)and cervical intervertebral fusion(ACDF).Methods:Part ?:The fixed-point rotational reduction method is used to treat cervical spondylosis.The self-control test method before and after treatment is adopted.Thirty patients who meet the criteria of subject inclusion are given fixed-point rotational reduction method to take X-ray of cervical vertebra before treatment.VAS score is collected.Fixed-point rotary reduction therapy was given once a week,followed up for 3 consecutive months,and the imaging changes before and after treatment were compared.To evaluate the clinical effect of fixed-point rotational reduction on cervical spondylosis patients and the changes of cervical sagittal parameters.Part ?:Study on Changes of Sagittal Parameters after Cervical Disc Replacement for Cervical Spondylosis A retrospective analysis was conducted on 79 patients(34 cases of single segment and 45 cases of double segment)who underwent cervical disc replacement in our hospital and 77 patients(32 cases of single segment and 45 cases of double segment)who underwent anterior disc resection and fusion.The sagittal parameters C2-7 Cobb angle(C2-C7 Cobb Angle),C2-C7 sagittal vertical axis(SVA),T1 slope(T1 Slope,T1S)and surgical segment angle(SA)of cervical lateral X-ray films before and during the last follow-up were measured.Statistical methods were used to evaluate the clinical effect of cervical disc replacement on cervical spondylosis patients and the changes of cervical sagittal parameters.Paired sample T was used to test and compare the differences of parameters before and after operation in the same group.Independent sample T was used to examine and compare the differences of imaging parameters between different groups before and after the operation.Pearson correlation was used to analyze the correlation between imaging parameters before and after surgery.Results:Part ?:The VAS score before and after treatment was(7.1 ±1.3)points before treatment,and(1.2±1.5)points after treatment.The VAS score after treatment was significantly lower than that before treatment(P<0.05).In this group,23 cases were cured,17 cases were effective,5 cases were ineffective,and the total effective rate was 88.9%.Changes in sagittal parameters of cervical spine imaging before and after T1S treatment(24.63±4.25)° and(22.87±5.93)°;C2-7cobb was(9.30±9.00)° before and(9.74±7.89)° after treatment.C2-7sva was(15.43±8.97)° before and(14.84± 7.05)°after treatment.There was no significant change of sagittal parameters before and after manipulative treatment.Part ?:At the last follow-up after operation,SA and T1S in single-segment cTDR and ACDF groups were significantly increased compared with those before operation,with statistical significance(p<0.05).The comparison between the two groups showed that the recovery angle of cervical SA segment in cTDR group was better than that in ACDF group,with statistical significance(P<0.05).Pearson analysis results of imaging parameters of the two groups showed that T1S,C2-7 Cobb angle and SA were positively correlated with each other(P<0.05).C2-7 SVA was negatively correlated with T1S,C2-7 Cobb angle and SA(P<0.05).The SA,C2-C7 Cobb angle,C2-C7 SVA value and T1S in the double-segment cTDR group increased at the last postoperative follow-up compared with those before operation,with statistical significance(p<0.05).At the last follow-up after operation,SA,C2-C7 Cobb angle,C2-C7 SVA value and T1S in ACDF group had no significant difference compared with those before operation(p>0.05).Compared with ACDF group,there was no significant difference in SA,C2-C7 Cobb angle,C2-C7 SVA value and T1S between ACDR group and ACDF group before operation(P>0.05).There was significant difference in SA and C2-C7 Cobb angle between the two groups at the last follow-up after operation(P<0.05).There was no significant difference in C2-C7 SVA value and T1S between the two groups at the last follow-up after operation(P>0.05).Pearson analysis results of imaging parameters of the two groups showed that T1S,C2-7 Cobb angle and SA were positively correlated with each other(P<0.05).Conclusion:Compared with the two surgical treatment methods,single-segment and double-segment cTDR can restore the angle of the surgical segment and improve the balance of cervical sagittal parameters.However,for patients with single-level cervical spondylosis,the cervical vertebra replacement segment angle that ACDF can partially restore and T1 inclination angle can be adjusted.For patients with double-level cervical spondylosis,the sagittal parameters of cervical vertebra have no obvious influence after ACDF treatment.Therefore,cervical intervertebral disc replacement has more advantages than fusion in restoring the angle and sagittal parameters of the replacement segment of cervical spondylosis patients.