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| LI Chuang,WU Bin,WU Yongchao.Clinical outcomes of artificial cervical disc replacement in cervical spondylosis[J].Chinese Journal of Spine and Spinal Cord,2020,(12):1088-1096. |
| Clinical outcomes of artificial cervical disc replacement in cervical spondylosis |
| Received:January 08, 2020 Revised:July 19, 2020 |
| English Keywords:Cervical spondylosis Artificial cervical disc replacement Anterior cervical decompression and fusion Clinical effect |
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| English Abstract: |
| 【Abstract】 Objectives: To observe and analyze the clinical effect of artificial cervical disc replacement(AC?鄄DR) in cervical spondylosis, and to compare the effect with that of anterior cervical decompression and fusion (ACDF) in the same period. Methods: A retrospective analysis was performed on 21 patients with cervical spondylopathy who were treated with ACDR from July 2009 to April 2015. The ACDR group included 17 males and 4 females, aged from 20 to 49 years with an average age of 39.1±6.8 years. There were 4 cases of C3/4, 6 cases of C4/5, 9 cases of C5/6, and 2 cases of C6/7. 21 cases of cervical spondylopathy patients received ACDF in the same period were collected for comparison. The ACDF group included 16 males and 5 females, aged 23-53 years with an average age of 39.5±6.3 years. There were 4 cases of C3/4, 7 cases of C4/5, 8 cases of C5/6, and 2 cases of C6/7. Postoperative follow-up included: X-ray film, cervical curvature, range of motion(ROM) in surgical segment, disc prosthesis loosing and displacement, ectopic ossification, inter?鄄vertebral fusion device loosing and displacement, and bone graft fusion. JOA score, visual analogue scale of pain score(VAS), neck disability index (NDI) and Odom′s grading were used to evaluate the clinical outcomes.Results: The patients in the two groups were followed up for 4-9 years, with an average of 5.7±1.2 years. There was no significant difference between the two groups in the follow-up time. No loosening or displace?鄄ment of disc prosthesis or intervertebral fusion device was observed at the last follow-up. ACDR group pre?鄄sented 1 case of ectopic ossification without obvious adjacent segment degeneration. There was no significant difference of cervical curvature and surgical segment ROM between preoperation and the last follow-up(P>0.05). X-ray in ACDF group showed osseous fusion of all surgical segments. There were 5 cases with obvious adjacent segment degeneration(ASD) in X-ray, among which 3 cases had no clinical symptoms, and 2 cases had severe clinical symptoms and underwent surgical treatment again. The cervical curvature and surgical segment ROM at preoperation and the last follow-up were with significant differences(P<0.05). There were sig?鄄nificant differences in the JOA, VAS and NDI scores in both groups at preoperation and the last follow-up(P<0.05), but there was no statistically significant difference of the scores between the two groups(P>0.05). The excellent and good rate of Odom′s classification at the last follow-up in ACDR group was 90.5%, and that in ACDF group was 85.7%, with significant difference between the groups(P<0.05). The incidence of ASD between the groups had statistically significant difference(ACDR 0 vs ACDF 23.8%, P<0.05). Conclusions: ACDR has satisfactory outcomes in mid- and long-term follow-up for cervical spondylosis, which can retain the motion range of the replacement segment, reconstruct the maximum possible cervical curvature, and reduce the degeneration of adjacent segments. |
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