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| SONG Qingpeng,TIAN Wei,HE Da.Long-term efficacy of cervical artificial disc replacement for the treatment of cervical spondylotic myelopathy[J].Chinese Journal of Spine and Spinal Cord,2018,(2):144-150. |
| Long-term efficacy of cervical artificial disc replacement for the treatment of cervical spondylotic myelopathy |
| Received:December 05, 2017 Revised:January 16, 2018 |
| English Keywords:Cervical artificial disc replacement Cervical spondylotic myelopathy Bryan disc Long-term follow-up |
| Fund:北京市医管局“青苗”人才计划（编号：QML20160402）；北京市科学技术委员会专项经费资助项目（编号：Z161100000516134） |
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| English Abstract: |
| 【Abstract】 Objectives: To evaluate the long-term efficacy of cervical artificial disc replacement in patients with cervical spondylotic myelopathy. Methods: Retrospective analysis of 17 patients who underwent single-level Bryan artificial disc replacement for cervical spondylotic myelopathy with more than 10 years follow-up in our hospital between December 2003 and December 2007. The age ranged from 37 to 76 years(mean age, 57.2±8.9 years), including 13 males and 4 females. The involved levels were 3 cases of C4/5, 9 cases of C5/6, 5 cases of C6/7. According to the results of preoperative CT and MRI examination, the patients were divided into two groups, 7 patients in group of simply cervical disc herniation and 10 patients in group of combined with osteophyte. The radiographic evaluation indexes included the global and segmental range of motion(ROM), Cobb angle and incidence of high grade(grade 3-4) paravertebral ossification(PO) of operated segment. The clinical indexes included Japanese Orthopaedic Association(JOA) score, neck disability index(NDI) and Odom′s standard. The differences of clinical indexes and radiographic evaluation indexes were analyzed between the two groups, and in each group the difference was compared between preoperation and final fellow-up. The continuous variable data were analyzed by t-test. The grading evaluation data were analyzed by Mann-Whitney test. A P<0.05 was considered statistically significant. Results: The mean age of disc herniation group was 56.1±11.7 years old, including 5 males and 2 females, and 3 cases of C5/6 level, 4 cases of C6/7 level. The preoperative segmental ROM was 8.18°±3.70° and 9.07°±4.76° at final follow-up, mobility lost occurred in 1 case(14.3%); the preoperative global ROM was 42.78°±14.89° and 47.34°±6.93° at final follow-up, the preoperative segmental Cobb angle was 2.77°±1.08° and 2.37°±1.48° at final follow-up, segmental kyphosis occurred in 1 case, and the high level PO rate was 14.3%. The radiographic evaluation indexes(global and segmental ROM, and Cobb angle of operated segment) had no difference between preoperation and final follow-up. The mean age of combined osteophyte group was 57.9±7.0 years old, including 8 males and 2 females, and 3 cases of C4/5 level, 6 cases of C5/6 level, 1 case of C6/7 level. The preoperative segmental ROM was 11.46°±5.19° and 6.41°±4.87° at final follow-up, 3 cases(30.0%) occurred mobility lost; the preoperative global ROM was 45.53°±11.89° and 41.60°±13.45° at final follow-up, the preoperative segmental Cobb angle was 2.14°±1.35° and 1.29°±1.33° at final follow-up, segmental kyphosis occurred in 1 case, and the high level PO rate was 40.0%. The segmental ROM and Cobb angle were significantly decreased at final follow-up(P<0.05). In disc herniation group, the improvement rate of JOA score was (76.73±25.53)%, NDI% decreased by (12.29±6.26)%, and the satisfaction rate of Odom′s standard was 100.0%. In combined osteophyte group, the improvement rate of JOA score was (82.90±19.03)%, NDI% decreased by (10.00±4.32)%, and the satisfaction rate of Odom′s standard was 100.0%. The global and segmental ROM, Cobb angle of operated segment, JOA score, NDI% and Odom′s criteria had no significant difference between the two groups at final follow-up(P＞0.05). Conclusions: Cervical artificial disc replacement has a satisfied long-term clinical efficacy in the treatment of cervical spondylotic myelopathy. The maintenance of ROM at operated level of cervical artificial disc replacement in cervical spondylotic myelopathy patients caused by simply disc herniation is better than those caused by osteophyte. |
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