Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (15): 2341-2346.doi: 10.3969/j.issn.2095-4344.3799

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Changes in sagittal parameters of cervical spine after double-segment artificial cervical disc replacement and anterior cervical discectomy and fusion

Chen Jiang1, 2, Li Jinyu1, Zheng Chenying1, Bai Chunxiao1, Zhang Fan1, Liu Chuyin1, Zhao Xueqian1, Yuan Qiaomei1, Di Xueshi1, Kang Shengqian1, Jia Yusong1    

  1. 1Department of Orthopedics and Traumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; 2Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China 
  • Received:2020-07-28 Revised:2020-07-29 Accepted:2020-09-01 Online:2021-05-28 Published:2021-01-04
  • Contact: Jia Yusong, Chief physician, Professor, Doctoral supervisor, Department of Orthopedics and Traumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • About author:Chen Jiang, MD, Associate chief physician, Master’s supervisor, Department of Orthopedics and Traumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81603638 (to CJ); the China Postdoctoral Science Foundation, No. 222921 (to CJ); the Basic Scientific Research Business Expenses of Beijing University of Chinese Medicine in 2018, No. 2018-JYB-XJQ010 (to CJ); the Young Talent Project of Dongzhimen Hospital of Beijing University of Chinese Medicine, No. DZMYS-201702 (to CJ) 

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Abstract: BACKGROUND: Cervical biomechanics has become a focus of research in recent years. Exploring the influence of different surgical methods on cervical sagittal position parameters can better optimize preoperative surgical plan design and achieve better clinical efficacy.   
OBJECTIVE: To investigate the effects of double-segment cervical total disc replacement and anterior cervical discectomy and fusion on sagittal parameters in the treatment of cervical spondylosis. 
METHODS: Ninety cases of cervical spondylosis of two adjacent segments of nerve root type or spinal cord type from October 2014 to December 2018 at Dongzhimen Hospital of Beijing University of Chinese Medicine were retrospectively analyzed. Of them, 45 cases received double-segment cervical total disc replacement (replacement group), and 45 cases received double-segment anterior cervical discectomy and fusion (fusion group). The sagittal parameters of the cervical vertebra at preoperation and the last follow-up were measured, including segment angle, C2-C7 Cobb angle, C2-C7 sagittal axial distance and T1 slope. The difference between the two groups was compared before and after operation. Pearson correlation was used to analyze the correlation between imaging parameters before and after surgery. This trial was approved by the Ethics Committee of Dongzhimen Hospital of Beijing University of Chinese Medicine.  
RESULTS AND CONCLUSION: (1) The operative segment angle, C2-C7 Cobb angle, C2-C7 sagittal axial distance and T1 inclination angle in the final follow-up of the replacement group were all increased compared with those before the surgery (P < 0.05), and the above indicators in the final follow-up of the fusion group were not significantly changed compared with those before the surgery (P > 0.05). The operative segment angle and C2-C7 Cobb angle in the replacement group were higher than those in the fusion group (P < 0.05). (2) Before surgery, T1 inclination angle of the replacement group was positively correlated with segmental angle, C2-C7 Cobb angle and C2-C7 sagittal axial distance (P < 0.05), while C2-C7 Cobb angle was positively correlated with segmental angle (P < 0.05). At the last follow-up, T1 inclination angle was positively correlated with segment angle and C2-C7 Cobb angle (P < 0.05), and segment angle was positively correlated with C2-C7 Cobb angle (P < 0.05). (3) Before (or after) surgery, T1 inclination angle of fusion group was positively correlated with segmental angle, C2-C7 Cobb angle and C2-C7 sagittal axial distance (P < 0.05), while C2-C7 Cobb angle was positively correlated with segmental angle of fusion group (P < 0.05). (4) The results showed that compared with cervical discectomy and fusion therapy, double-segment artificial intervertebral disc replacement therapy had advantages in restoring segmental angle and sagittal position parameters of cervical spondylopathy.

Key words: bone, implant, cervical spondylosis, artificial disc replacement, spinal fusion, sagittal parameters

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