ObjectiveTo explore the surgical indication and summarize the experiences of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylosis. MethodsSeventy-five cases of cervical spondylosis were treated with ACDF from January 2010 to October 2013, including 34 cases of cervical spondylotic radiculopathy and 41 cases of cervical spondylotic myelopathy. The pre/post-operative Japanese Orthopedic Association (JOA) score and imaging data were observed. ResultsThirty-six patients were followed up for 6 to 25 months, with an average of 16 months. The mean JOA score before surgery was 10.67±2.66, and 3 months later, the score was 13.47±2.06. Six months later the score was 14.11±1.56, and after 12 months the score was 14.97±1.78. No spinal cord injury or esophagus, trachea injury occurred, and there was no superior laryngeal nerve and recurrent laryngeal nerve injury during the operation. Eight cases of postoperative dysphagia obviously decreased within 3-5 days, 6 cases decreased within 5-7 days, and 10 cases decreased within 3 weeks. And all 36 patients recovered within one month. There was no titanium mesh subsidence, displacement or titanium plate failure after operation. ConclusionACDF is suitable for the decompression of spinal cord or nerve root which is compressed by the degenerated intervertebral disc, especially without rigid kyphosis, ossification of the posterior longitudinal ligament extending across multiple segments, and the compression located at the level of intervertebral disc. The appropriate approach can achieve a stable efficacy, less interference on the stability of the spine, and the incision heals fast. It is a kind of classic anterior cervical operation for it can reduce the complication effectively.
ObjectiveTo analyze the effectiveness of a new type of decellularized allogeneic bone in the application of anterior cervical discectomy and fusion (ACDF). MethodsA retrospective analysis was made on the clinical data of 73 patients with single segmental cervical spondylosis treated with ACDF between January 2009 and December 2013. Of 73 cases, autologous iliac bone was used in 22 cases (group A), new decellularized allogeneic bone transplantation (Bio-Gene) in 22 cases (group B), and normal allogeneic bone (Xin Kang Chen) in 24 cases (group C). There was no significant difference in gender, age, type of cervical spondylosis, course of disease, and involved segment among 3 groups (P>0.05). The operation time, intraoperative blood loss, and complications were compared between groups; X-ray films and CT images were taken to observe the bone fusion, and Japanese Orthopaedic Association (JOA) score was used to assess the clinical efficacy. ResultsThe operation time and intraoperative blood loss of group A were significantly more than those of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Pain and numbness at donor site occurred in 12 cases, and poor healing in 1 case of group A; red swelling and exudate were observed in 1 case of group B and in 6 cases of group C; and there was significant difference in complications among 3 groups (χ2=18.82, P=0.00). All patients were followed up 6-54 months (mean, 30 months). The graft fusion rate was 100% in groups A and B, and was 95.8% in group C, showing no significant difference (χ2=2.04, P=0.36). The JOA score at 6 months after operation were significantly improved when compared with preoperative score in 3 groups (P<0.05), but no significant difference was found among the 3 groups at preoperation and 6 months after operation (P>0.05). The excellent and good rates of groups A, B, and C were 90.9%, 88.9%, and 87.5% respectively, showing no significant difference (χ2=0.14, P=0.93). ConclusionNew type of decellularized allogeneic bone in ACDF has the advantages of shorter operation time, less blood loss, and better early effectiveness. But whether there is a chronic rejection or delayed rejection needs further studies.
Objective To explore the neck axial symptom (AS) after Bryan cervical disc arthroplasty traditional anterior cervical discectomy and fusion, and to make contrastive analysis. Methods From October 2004 to April 2006, 22 patients, 13 males and 9 females, aged 33-54 years old (43.3 on average), underwent Bryan cervical disc placement (groupA). Among them, there were 16 cases of cervical spondylotic myelopathy and 6 of nerve root cervical syndrome, with 20of single segment replacement and 2 of two segments replacement. The courses of disease were 1-21 months (6 months on average). Meanwhile, 30 patients, 17 males and 13 females, aged 35-64 years old (50.3 on average) underwent traditional anterior cervical discectomy and fusion (group B). Among them, there were 19 cases of cervical spondylotic myelopathy and 11 of nerve root cervical syndrome, with 26 of single segments replacement and 4 of two segments replacement. The course of disease was 1-23 months (7 months on average). In both groups, the neurologic recovery rate, the change of cervical curvature of the operated segments and total range of motion (ROM), and incidence of neck axial symptoms were recorded and compared. Results All the patients were followed up for 24-42 months (30.6 months on average). There was no graveness compl ication happening during and after operation in both groups. There were no compl ications of prosthesis bit shifting and amotio in group A, and group B exhibited a bony fusion on X-ray films 6 months after operation, without plate and bolt loose or broken. The patients’ cl inical symptoms of radiculopathy were obviously rel ieved and the curative effect was satisfactory in two groups of nerve root cervical syndrome. In both groups of cervical spondylotic myelopathy, the patients’ JOA scores at the postoperative follow-up increased obviously than preoperative (Plt; 0.01), and there was no significant difference between the two groups before the operation and at the end of the follow-up (P gt; 0.05). The rate of sagittal al ignment of the operated segment with kyphosis increased obviously in group B, higher than in group A (P lt; 0.05).The total ROM of group B was obviously lower than preoperative (Plt; 0.01), and the pre- and postoperative difference of group A was not statistically significant (P gt; 0.05). The rate of postoperative neck AS was 18.18% in group A and 46.67% in group B, and the difference was statistically significant(Plt; 0.05). Conclusion Compared with traditional anterior cervical discectomy and fusion, the use of Byran disc arthroplasty for cervical syndrome is associated with good outcomes. At the same time, it can maintain the cervical motion and curvature of operated segments, avoid the decrease of total ROM and lower the incidence of the postoperative neck AS.
In the context of accelerated rehabilitation, nutritional support for patients with orthopedic cervical spondylosis is an important condition for lessening postoperative stress response, reducing postoperative complications, shortening patient’s length of hospital stay, lowering medical expenses, and promoting early recovery of patients. Based on this, West China Hospital of Sichuan University explored and established the West China Hospital program for nutritional management in cervical spondylosis from the aspects of team building, nutritional assessment and monitoring, and nutritional intervention.
Anterior cervical decompression and fusion (ACDF) treatment for cervical spondylosis has been more than half a century, and achieved good clinical results. However, with the continuous extension of follow-up time, the fusion segment-associated postoperative complications emerged gradually. Reserved cervical stability and activity, the concept of non-fusion was born. As a non-fusion technique, cervical artificial disc replacement (CADR) developed rapidly. With the continuous development of artificial prosthesis materials and design concepts, and specification and proficiency of surgical procedures, CADR has achieved better short- and mid-term clinical efficacy than ACDF. Compared with ACDF, the main advantages of CADR are that the postoperative recovery is quick, the activity and stability of cervical vertebra are maintained, the height of cervical intervertebral space is restored, and the stress of adjacent segments and the rate of surgical renovation are reduced. In clinical work, as an emerging technology, CADR requires spine surgeons to control the surgical indications, contraindications, and patients’ conditions strictly. This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.
Objective To retrospectively analyze the long-term effectiveness of percutaneous laser disc decompression (PLDD) in treatment of cervical spondylosis. Methods Between March 2003 and June 2005, 156 patients with cervical spondylosis were treated with PLDD. There were 74 males and 82 females with an average age of 55.4 years (range, 31-74 years). The disease duration varied from 2 months to 15 years. Fifty-nine patients were classified as cervical spondyloticradiculopathy, 48 as vertebral-artery-type cervical spondylosis, 19 as cervical spondylotic myelopathy, and 30 as mixed type spondylosis. The lesions were located at the levels of C3,4 in 32 discs, C4,5 in 66 discs, C5,6 in 89 discs, and C6,7 in 69 discs, and including 71 one-leve lesion and 85 multi-level lesions. All cases were followed up to study the long-term effectiveness and correlative factors. Results A total of 117 (75%) patients’ symptoms were l ightened or eased up immediately after operation. Discitis occurred in 1 case at 3 days after operation and was cured after 3 weeks of antibiotic use. All patients were followed up 5 years to 7 years and 3 months (5 years and 6 months on average). According to Macnab criteria, the long-term effectiveness was excellent in 60 cases (38.46%), good in 65 cases (41.67%), fair in 19 cases (12.18%), and poor in 12 cases (7.69%); the excellent and good rate was 80.13%. No significant difference was observed in the wedge angels and displacements of the intervertebral discs between before and after operations (P gt; 0.05). Multiple-factors logistic regression showed that the disease duration and patient’s age had obvious relationship with the effectiveness of treatment (P lt; 0.05), while the type of cervical spondylosis, disc protrusion degree, mild cervical instabil ity, and lesion scope had no correlation with the effectiveness of treatment (P gt; 0.05). Conclusion PLDD is safe and effective in treatment of cervical spondylosis with less compl ication. There is no impact on the stabil ity in cervical spinal constructs. The disease duration and patient’s age have obvious impact on the long-term effectiveness of treatment. The type of cervical spondylosis, disc protrusion degree, cervical instabil ity, and lesion scope are not the correlative factors.
Objective To study the effectiveness of artificial disc replacement for cervical diseases and the adjacent segment degeneration. Methods Between January 2008 and October 2010, 39 cases of cervical spondylosis underwent cervical disc replacement. Of them, there were 20 males and 19 females with an average age of 45.7 years (range, 32-60 years)and an average disease duration of 30 months (range, 1 month to 10 years), including 26 cases of cervical myelopathy, 11 cases of nerve root cervical spondylosis, and 2 cases of mixed cervical spondylosis. Single level disc lesion was observed in 27 cases while bi-level lesion in 12 cases. Prestige disc prosthesis was used in 9 patients, Prodisc-C prosthesis in 4 patients, and Discover disc prosthesis in 26 patients. The neurological functional recovery was assessed after operation by Japanese Orthopaedic Association (JOA) score. The range of motion of replaced segment and adjacent segments was measured (Cobb angle), and Kellgren’s X-ray assessment was used to evaluate the degree of adjacent segment degeneration. Results The operation was successfully performed in all cases, with primary heal ing of all the incisions. All patients were followed up from 12 to 36 months with an average of 23.1 months. JOA score was significantly improved at last follow-up when compared with preoperative score (P lt; 0.05), and no significant difference was observed in the Cobb angle of replaced segment and adjacent segments between pre- and postoperation (P gt; 0.05). According to the Kellgren’s X-ray assessment, degeneration of the adjacent segments occurred in 5 cases at last follow-up, including 3 cases of degeneration from grade 0 to grade 1 or 2, 1 from grade 1 to grade 2, and 1 from grade 2 to grade 3, with a degeneration rate of 12.8%, but no significant difference was found in degeneration degree when compared with preoperative value (χ2=1.793，P=0.406). No degeneration of adjacent segments occurred in 32 patients at 15 months after operation. Conclusion Artificial disc replacement has a good effectiveness in treating cervical spondylosis, which can maintain the range of motion of the replaced segment and adjacent segments, and may have a protective effect on adjacent segment discs.
To compare and evaluate the whole effect of anterior decompression approach to treat cervical spondylotic myelopathy by using cervical retractor systems and the traditional surgical approach. Methods From April 2001 to August 2004, group A included 30 males and 23 females aging from 31 to 69 years, and the involved time was from 7 months to 15 years. Involved segments included 22 one-segments, 24 two-segments and 7 three-segments. In all 53 cases, anterior windowing decompression and fusion with autograft and titanium plate internal fixation by using traditionalcircular saw were performed. Group B included 48 males and 20 females aging from 33 to 74 years, and the involved time was from 5 months to 18 years. Involved segments included 23 one-segments, 34 two-segments and 11 three-segments. In all 68 cases, anterior undermined far-reaching decompression and fusion with autograft and titanium plate internal fixation by using removing disc merely in the single-level or separately in the multilevels employing self-retractor and Caspar cervical retractor systems via interspinal approach were performed. X-rays and MRI showed cervical disc degeneration, herniation and spinal cord compression. The surgery time, loss of blood, vertebral body fusion time, difference in height of involved segments preor postoperatively and compl ications were counted up and compared between the two groups. Improvement rate of spinal function pre- or postoperatively were valued by using JOA score. Results A total of 92 cases including 42 of group A and 50 of group B were followed up for 3 to 5 years, mean 3.5 years. In group A, surgery time, loss of blood, time of vertebral body fusion, difference in height of involved segments pre- or postoperatively, and improvement ratio of spinal function were(76.80 ± 28.41) min,(564.00 ± 181.96) mL,(12.10 ± 3.58) weeks, (1.30 ± 0.67) mm and 0.49% ± 0.14%, respectively. In group B, they were(57.90 ± 15.01) min,(317.50 ± 136.92) mL,(9.75 ± 1.36) weeks, (3.00 ± 0.56) mm and 0.71% ± 0.17% , respectively. The differences between the two groups were significant in all measured values(P lt; 0.05). Compl ications occurred in 7 cases ofgroup A including 1 spinal cord injury, 1 plate displacement, 1 bonegraft displacement and 4 disfunctions of il iac region. No compl ication happened in group B. Conclusion Anterior decompression approach using cervical retractor systems is significantly superior to the traditional approach as to the whole effect to treat cervical spondylotic myelopathy, and furtherperfects the traditional anterior decompression approach. The modified approach is scientific, safe and easily spread.
Objective To investigate the cl inical effect of cervical artificial disc replacement (CADR) on twosegment cervical spondylosis and to research its influences on the range of motion (ROM) of the diseased segments and theadjacent superior and inferior segments. Methods From September 2004 to February 2007, 7 cases with cervical spondylosis at C4,5 and C5,6 were treated with CADR using Bryan artificial disc prosthesis, including 4 males and 3 females aged 30-45 years old (average 38.5 years old). All the patients had cervicodynia in various degrees, pain and numbness of l imbs and decreased muscle strength, including 3 cases of cervical spondylotic radiculopathy, 3 of cervical spondylotic myelopathy and 1 of mixed cervical spondylosis. The course of disease was 12-54 months (average 27 months). Preoperatively, X-ray films revealed the intervertebral space of C4, 5 and C5,6 was narrowed and the cervical curve became straight, CT or MRI showed the intervertebral disk hernia of C4, 5 and C5,6, and the hyperostosis of vertebral margin compressed nerve root or spinal cord. All the patients had no response to the preopratively conservative treatment. JOA score and ROM of the diseased segments and the adjacent superior and inferior segments were compared before and after operation. Results All the patients survived the perioperative period, without hoarse voice, muscle spasm, dysphagia and cervicodynia. X-ray films showed the implanted prosthesis was well located, the height of intervertebral space was normal, and no prosthesis loosening, prosthesis migration and infection occurred 12 months after operation. All the 7 cases were followed up for 12-41 months (average 26.7 months). Cervicodynia and l imbs’pain and numbness disappeared, and muscle strength was improved obviously. The JOA score before and during the followup period was (8.35 ± 1.27) and (14.65 ± 1.61) points, respectively, indicating there was a significant difference (P lt; 0.05). For the ROM of C4,5 and C5,6, it was (8.38 ± 0.48)° and (9.16 ± 0.54)° before operation, respectively, and it increased to (11.15 ± 0.65)° and (12.75 ± 0.73)° after operation, respectively, showing there was a significant difference (P lt; 0.05). The ROM at C3,4 and C6,7 before operation was (9.71 ± 0.76)° and (12.39 ± 0.58)°, espectively, while it was improved to (10.26 ± 0.47)° and (13.67 ± 0.71)° after operation, respectively, indicating there were no significant differences between before and after operation (P gt; 0.05). Conclusion The appl ication of Bryan Disc CADR for two-segment cervical spondylosis has satisfying therapeutic effects, can improve the ROM of diseased segments obviously, and has minor influences on the ROM of adjacent superior and inferior segment.
The incidence of perioperative sleep disorders in patients with cervical spondylosis is high, which affects the physiological and psychological rehabilitation effect of patients after surgery. The expert consensus (preliminary draft) was prepared by summarizing expert experience and recommendations. After expert review and revision, the consensus was formed. The consensus was developed based on existing evidence-based medical evidence and expert clinical experience, which is scientific and practical and can provide a basis for clinical medical personnel to prevent and treat perioperative sleep disorders in patients with cervical spondylosis.