Anterior cervical decompression and fusion versus anterior cervical disc replacement for single-level cervical spondylosis: evaluation of mid-term outcomes

doi:10.3969/j.issn.2095-4344.2014.48.003

Abstract

Abstract:

BACKGROUND: Spinal fusion is a classical surgical therapy for cervical spondylosis. The concept of non-fusion disc replacement added new vitality for cervical spondylosis. In short-term stable efficacy of anterior cervical disc replacement has been recognized by scholars. However, interim efficacy is inconclusive. What’s more, it is a worth exploring problem about the different adjacent segment degenerative changes between replacement and fusion.
OBJECTIVE: To compare mid-term curative effects of anterior cervical decompression and fusion and anterior cervical disc replacement for single-level cervical spondylosis.
METHODS: A total of 114 cases of single-level cervical spondylosis, who were treated in the Department of Spinal Surgery, First Affiliated Hospital, Xinjiang Medical University from January 2008 to December 2010, were
retrospective reviewed. Of them, 86 cases underwent anterior cervical decompression and fusion fixation, and 28 cases received artificial cervical disc replacement. Operation time, blood loss, Japanese Orthopaedic Association score, neck and upper limb visual analog scale score, neck disability index and adjacent segment degenerative changes were compared. Odom criterion and improved excellent and good rate of Japanese Orthopaedic Association score were used to evaluate the clinical effect.
RESULTS AND CONCLUSION: (1) Japanese Orthopaedic Association scores, visual analog scale score and neck disability index were significantly improved during final follow-up than before treatment in patients of both groups (P < 0.05). There were no significant differences in operation time, blood loss, Japanese Orthopaedic Association score before treatment and during final follow-up, visual analog scale score and neck disability index between the two groups (P > 0.05). The excellent and good rate of Japanese Orthopaedic Association score was 86% in the anterior cervical decompression and fusion group and 89% in the anterior cervical disc replacement group. According to Odom criterion, the excellent and good rate was 83% in the anterior cervical decompression and fusion group and 93% in the anterior cervical disc replacement group, showing no significant difference (P > 0.05). (2) Adjacent segment affected degeneration in 22 cases in the anterior cervical decompression and fusion group during final follow-up. There were 15 cases of upper segment and 7 cases of lower segment. Of the 22 cases, 3 cases had clinical symptoms, and received secondary surgery. In the anterior cervical disc replacement group, two cases suffered from adjacent segment degeneration, including one case of upper segment and one case of lower segment. None of them received secondary surgery. Above results suggested that the mid-term curative effects are identical between anterior cervical decompression and fusion and anterior cervical disc replacement. The incidence of adjacent segment degeneration is low in anterior cervical disc replacement. The upper segment easily affected degeneration after anterior cervical decompression and fusion.

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

全文链接：

Key words: cervical vertebrae, intervertebral disk, spinal fusion

CLC Number:

R318

Luo Hao, Wang Jian, Liang Wei-dong, Sheng Wei-bin. Anterior cervical decompression and fusion versus anterior cervical disc replacement for single-level cervical spondylosis: evaluation of mid-term outcomes[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7719-7725.

Figures/Tables 2

访1年后失访。随访完成的114例患者中前路减压植骨融合组随访30-61个月，人工颈椎间盘置换组随访35-58个月。 2.2 基线资料比较两组患者一般资料相比，差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 术中及术后基本情况前路减压植骨融合组手术时长(132±21) min，术中出血(127±39) mL，随访时间30-61个月。人工颈椎间盘置换组手术时间(123±21) min，术中出血(130±30) mL，随访时间35-58个月。两组患者手术时长、术中出血量、随访时间差异均无显著性意义 (P > 0.05)。 2.4 临床疗效前路减压植骨融合组末次随访时JOA改善优良率为86%；按照Odom疗效评定标准：优38例，良33例，可9例，差6例，优良率为83%。人工颈椎间盘置换组末次随访时JOA改善优良率为89%；按照Odom疗效评定标准：优23例，良3例，可2例，优良率93%。两组患者治疗前及末次随访时JOA评分、目测类比评分及NDI如表2所示，组内比较差异均有显著性意义(P < 0.05)。两组患者JOA评分、目测类比评分及NDI末次随访时与治疗前差值如表3所示，组间比较差异无显著性意义 (P > 0.05)。 2.5 手术邻近节段退行性改变前路减压植骨融合组与人工颈椎间盘置换组两组退变情况见表4-6。前路减压植骨融合组有22例出现邻近节段退变，其中15例发生在上位节段(2例出现临床症状者椎间盘退变指标均出现，另有3例出现椎间盘退变加重患者同时出现异位骨化)，7例发生在下位节段(1例出现临床症状者椎间盘退变指标均出现，另有1例出现椎间盘退变加重患者同时出现异位骨化)。人工颈椎间盘置换组有2例邻近节段退变，上位节段与下位节段各1例。两种修复方式退变情况差异有显著性意义(P < 0.05)；前路减压植骨融合后邻近节段退变患者退变发生部位差异有显著性意义(P < 0.05)。 2.6 并发症情况两组患者均无术中大出血(大于 500 mL)，脑脊液漏、神经症状、声音嘶哑、食管瘘、吞咽困难、脊髓损伤、死亡病例。无新发呼吸道感染、泌尿系感染、脑血管意外、心血管意外病例，术后3年内无再次手术。前路减压植骨融合组有7例围手术期切口感染，加强换药后痊愈出院；2例因邻近节段退行性改变分别于术后72，79个月再次手术。人工颈椎间盘置换组有2例围手术期切口感染，换药处理后痊愈出院；虽有影像学退变但未出现临床症状至随访结束时无患者再次手术。 2.7 典型病例典型病例1：患者男性，51岁，以“颈肩部活动受限伴右上肢疼痛麻木3年”为主诉入院，诊断为C5/6椎间盘突出症，见图1。典型病例2：患者女性，44岁，以“颈部疼痛3年伴左上肢疼痛麻木1年”为主诉入院，诊断为C5/6椎间盘突出症，见图2。"

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