Influence of the artificial disc size on cervical artificial disc replacement

doi:10.3969/j.issn.2095-4344.0160

Abstract

Abstract:

BACKGROUND: The size of artificial disc is not exactly identical to cervical vertebral endplate. However, the effect of implant size on cervical disc replacement has not yet been clearly identified.

OBJECTIVE: To evaluate the effect of Bryan disc size on cervical artificial disc replacement.

METHODS: Totally 71 patients with cervical degenerative disease underwent single-level Bryan disc replacement from December 2003 to December 2007 were enrolled. The average age was (45.90±8.12) years old, and all patients were followed up for more than 10 years. The artificial disc size was measured using lateral X-ray films, and expressed as (Bryan artificial disc’s footprint sagittal diameter×2) / (upper endplate sagittal diameter + lower endplate’s sagittal diameter)×100%. X-ray films were photographed to measure motion range of the treated segment before surgery, 3 months after surgery, and during final follow-up. Clinical outcomes, including Japanese Orthopaedic Association score, Neck Disability Index and Odom’s scores, were evaluated before and after operation. Observational indexes of different disc sizes (≥95% and <95% groups) were compared and analyzed.

RESULTS AND CONCLUSION: (1) There were 49 patients in the ≥95% group and 22 patients in the <95% group. (2) At 3-month follow-up, range of motion was significantly smaller in the <95% group than in the ≥95% group (P < 0.01). At the final follow-up, range of motion was significantly smaller in the <95% group than in the ≥95% group (P < 0.05). (3) At final follow-up, improvement rate of Japanese Orthopaedic Association score was (70.65±32.58)% in the <95% group and (68.83±38.85)% in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (4) At final follow-up, Neck Disability Index decreased by (10.82±7.50)% in the <95% group, and (12.61±8.51)% in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (5) At final follow-up, Odem’s score results showed excellent in 10 cases (45%), good in 9 cases (41%) and average in 3 cases (14%) in the <95% group; and excellent in 26 cases (53%), good in 20 cases (41%) and average in 3 cases (6%) in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (6) Results suggest that different sizes of artificial disc replacement have obtained good functional recovery, but small artificial disc may impact the range of motion. We should try to avoid placing the artificial disc smaller than 95%.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical Vertebrae, Follow-Up Studies, Tissue Engineering

CLC Number:

R318

Song Qing-peng, Tian Wei, He Da, Han Xiao, Wang Jin-chao, Li Zu-chang, Feng Xiao. Influence of the artificial disc size on cervical artificial disc replacement[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(11): 1665-1670.

Figures/Tables 3

2.1 参与者数量分析符合入组条件患者共89例，完成10年以上随访患者共71例，10年以上随访率为80%。其中人工间盘大小<95%组22例，≥95%组49例。试验流程图见图3。 2.2 基本资料人工间盘大小<95%组患者共22例，年龄(47.27±9.09)岁(33-69岁)；男15例，女7例；其中C3/4节段1例，C4/5节段6例，C5/6节段13例，C6/7节段2例；人工间盘的大小为(89.50±3.65)%；随访时间120-155个月。人工间盘大小≥95%组患者共49例，年龄(45.29±7.67)岁(26-64岁)；男29例，女性20例；其中C3/4节段1例，C4/5节段9例，C5/6节段32例，C6/7节段7例；人工间盘的大小为(98.66±2.80)%；随访时间121-154个月。 2组除人工间盘大小差异有显著性意义(P < 0.05)，其余数据差异均无显著性意义，见表1。 2.3 影像学评估结果术后3个月随访时，人工间盘大小<95%组置换节段活动度为(5.66±3.90)°，≥95%组为(11.33±3.69)°；末次随访时，人工间盘的大小<95%组置换节段活动度为(5.20±5.17)°，≥95%组为(10.09±4.80)°，差异有显著性意义(P < 0.05)，见表2。 2.4 临床功能评估结果 2.4.1 JOA评分人工间盘大小<95%组术前JOA评分为12.52±3.30(6.5-16.5)，末次随访时JOA评分改善率为(70.65±32.58)%；人工间盘大小≥95%组术前JOA评分为13.26±2.44(4.0-16.5)，末次随访时JOA评分改善率为(68.83±38.85)%，2组间各数据差异无显著性意义(P > 0.05)，见表3。 2.4.2 NDI 人工间盘大小<95%组术前NDI为(29.64± 11.34)%(16%-52%)，末次随访时NDI减低(10.82±7.50)%；人工间盘大小≥95%组术前NDI为(26.73±7.40)% (10%-50%)，末次随访时NDI减低(12.61±8.51)%。2组间各数据差异无显著性意义(P > 0.05)，见表3。 2.4.3 Odem’s评分末次随访时，人工间盘大小＜95%组Odem’s评分优10例(45%)，良9例(41%)，可3例(14%)；人工间盘大小≥95%组Odem’s评分优26例(53%)，良20例(41%)，可3例(6%)。2组间差异无显著性意义(P > 0.05)，见表3。"

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