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| RUAN Dike,HE Qing,ZHANG Chao.An over 10-year outcome of intervertebral disc allograft for degenerative cervical spine disease[J].Chinese Journal of Spine and Spinal Cord,2013,(4):289-295. |
| An over 10-year outcome of intervertebral disc allograft for degenerative cervical spine disease |
| Received:January 11, 2013 Revised:March 15, 2013 |
| English Keywords:Intervertebral disc transplantion Degenerative disc disease Safety Outcome |
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| English Abstract: |
| 【Abstract】 Objectives: To address the multi-center clinical and radiographic outcome of intervertebral disc allograft in patients with over 10-year follow-up as well as its safety and reliability. Methods: A prospective cohort study including 27 patients with a mean age of 45 years old with suffering from cervical degenerative disc disease and undergoing transplantation of fresh-frozen composite disc allograft was performed. Static and dynamic radiographs were performed to assess graft-complex integrity, segmental stability and mobility. Japanese Orthopedic Association(JOA) score was used to evaluate neurofunction. NDI, VAS and SF-36 were also utilized. Prospective data were collected at pre-operation, post-operation, 1, 3, 6, 12, 60 and 120 months after surgery. Serial MRI scans were performed before surgery and at 3, 6, 12 months and the final follow-up. As the indexes of degeneration, gray scales of discs based on MRI were measured by a modified Schneiderman′s score. Diffusion of nutrition across the endplate was assessed by using Gadolinium enhancement MRI. Adjacent discs were used as the control. Center of rotation(COR) in the allografted disc was also measured. Results: Neurological status improved in all patients and maintained throughout follow-up. Clinically, good and excellent outcomes were noted in 20 patients respectively. There was no complaint of neck or arm pain in the long time follow-up. Bony unions were noted between the grafted disc endplates and recipient vertebral bodies. Cervical lordosis was maintained in most of the cases. Spontaneous fusion of the grafted disc was noted in 1 patient as previously reported. All grafted discs presented a higher gray scale after transplantation. Compared with the control, 20 grafted discs showed a similar gray scale value, whereas another seven discs showed a relatively lower value. From T1-weighted imaging, contrast enhancement displayed gadolinium diffusion into the center of the disc in both the normal and grafted segments(P<0.05). Conclusions: The prospective and long-term follow-up outcomes demonstrate that cervical disc allograft is safe and effective. Despite of mild disc degeneration, there is still nutrition diffusion across the endplates, as well as the recovery of physiological rotation center, which is an alternative to conventional surgical intervention for degenerative cervical spine disease. |
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