椎间盘置换联合邻近节段cage融合治疗双节段颈椎间盘突出症的近期疗效

目的:探讨椎问盘置换联合邻近节段cage融合治疗双节段颈椎问盘突出症的近期疗效.方法:2006年5月～2008年11月手术治疗双节段颈椎间盘突出症患者13例,男8例,女5例,年龄35～60岁,平均47岁:以脊髓受压表现为主者6例,神经根性症状为主者7例;病变节段C4/5、C5/6 8例,C5/6、C6/7 3例,C4/5、C6/7 2例.均一期行单节段Bryan人工椎间盘置换和邻近节段cage融合,置换节段和融合节段为相邻间隙11例.非相邻间隙2例.术前、术后进行JOA评分(17分法)和颈椎残障功能量表(neck disability index,NDl)评定,术后进行Odom标准评定,随访观察椎间盘似体稳定性、假体活动度、cage融合状态及cage位移情况等.结果:手术时间90～160min,平均130min;术中m血量50～400ml,平均130ml.术中、术后无并发症发生.随访6个月～3年,平均19个月,末次随访时,JOA评分由术前9.2±3.2分增加至13.5±1.8分(P<0.01),NDI评分由术前40.8±4.7分降至28.5±5.4分(P<0.01),Odom评定结果优6例,良3例,尚可2例,差2例.人工椎间盘稳定,置换节段平均活动度为9.5°,cage植骨全部融合,无cage松动和沉陷.结论:颈椎间盘置换加邻近节段cage融合为双节段颈椎间盘突出症的治疗提供了新的选择方式,兼顾了颈椎的稳定和运动功能,近期临床效果良好.

Preliminary clinical outcome of artificial cervical disc arthroplasty combined with adjacent segment fusion for the treatment of double-level cervical disc herniation

Objective:To evaluate the preliminary clinical outcome of artificial cervical disc arthroplasty combined with adjacent segment fusion in the treatment of double-segmental cervical disc hemiation.Method: A total of 13 cases with double-level cervical disc herniation undergoing single-level Bryan disc arthroplasty combined with adjacent segment fusion from May 2006 to November 2008 were reviewed retrospectively.Of the patients, there were 8 male and 5 female with age between 35 and 60 years (mean, 47 years-old).6 cases complained with myelopathy and 7 patients with radiculopathy.Disc herniation was noted at C4/5 and C5/6 in 8 cases,C5/6 and C6/7 in 3 cases and C4/5 and C6/7 in 2 cases.The segment with respect to arthroplasty and fusion respectively sited as adjacent level in 11 patients,and as interval level 1 in 2 cases.The clinical symptom and neurological function before and after surgery were evaluated according the JOA score (17 points),neck disability index(NDI) and Odom's criteria.The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. Result:The operating time was 90-160min with an average of 130min.The volume of blood loose was 50-400ml with an average of 130ml.No intraoperative and postoperative complication was noted.The follow-up was 6 moths to 3 years.At final follow up,the JOA score was 13.5±1.8 compared with 9.2±3.2 of preoperation(f< 0.01),and the NDI was 28.5±5.4 compared with 40.8±4.7 of preoperation (P<0.01) ,the Odom's criteria was rated as excellent in 6 cases,good in 3 cases,fair in 2 cases and poor in 2 cases.All Bryan disc achieved definite stabilization.The average range of motion for arthroplasty level was 9.5° of flexion-extension. Solid fusion was achieved in all levels brought by cage.There was no cage subsidence or displacement.Conclusion:Artificial cervical disc arthroplasty combined with adjacent segment fusion provides a new effective alternative for cervical disc herniation.The definite stabilization and maintained ROM can be achieved contemporarily which can ensure a good preliminary clinical outcome.