关键词: 植入物, 人工假体, 人工椎间盘置换, 前路颈椎融合, 临床疗效

Abstract:

BACKGROUND: Fusion treatment for single segment cervical spondylosis can induce complications such as abnormal enlargement of range of motion in adjacent segments and degenerative manifestations. Recently, scholars began to explore and to use non-fusion technique to replace traditional fusion therapy. Cervical artificial disc replacement as a new anterior non-fusion program has been greatly used in the clinic, not only obtained good clinical therapeutic effects, but also made cervical vertebrae near physiological stability, delayed adjacent segment degeneration and reduced complications.
OBJECTIVE: To compare the clinical effects of the single level artificial disc replacement and the anterior cervical decompression and fusion for cervical spondylosis.
METHODS: A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrolled from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group (replacement group; n=32) and anterior cervical decompression and fusion group (fusion group; n=27). They were followed up at 5 days, 3, 6 and 12 months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed.
RESULTS AND CONCLUSION: The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores (P < 0.05), while Japanese Orthopaedic Association Scores were decreased compared with preoperative scores (P < 0.05). There were no significant differences between two groups (P > 0.05). Range of motion of the replacement segment after treatment was (11.6±3.0)° in the replacement group, showing no significant differences as compared with before surgery (8.8±2.7)° (P > 0.05). No significant activity was found at 3 months after treatment in the fusion group. During follow-up, the range of motion in the adjacent segments was smaller in the replacement group than in the fusion group (P < 0.05). No significant difference in the range of motion in the adjacent segments was detected before and after treatment in the replacement group (P > 0.05), but significant differences in the range of motion were detected before and after treatment in the fusion group (P < 0.05). The range of motion was apparently increased after treatment. These findings indicated that compared with the anterior cervical decompression and fusion, cervical artificial disc replacement can not only improve the clinical symptoms, restore nerve function, but also can keep the range of motion and stability of the cervical replacement segment. Moreover, it does not have impacts on the range of motion in the segments near to the surgical wound, and can effectively maintain cervical curvature.

Key words: cervical vertebrae, spinal fusion, internal fixators, follow-up studies