零切迹颈椎前路融合固定系统与传统融合器钢板内固定系统治疗单节段颈椎间盘突出症的病例对照研究

目的 :比较零切迹颈前路椎间融合固定系统(Zero-p)与传统钛板联合cage融合内固定术治疗单节段颈椎间盘突出症的临床疗效。方法:对2011年8月至2014年3月接受颈前路椎间盘切除植骨融合内固定术的139例单节段颈椎间盘突出症患者的临床资料进行回顾性分析,根据已采取的不同术式分为A,B两组,其中A组63例,行前路椎间盘切除与Zero-P融合内固定;B组76例,行前路椎间盘切除椎间cage融合与钢板内固定。分别于手术前后对患者进行JOA评分、Odom功能评级;采用电视透视吞咽研究(videofluorographic swallowing study,VFSS)评估患者椎前软组织厚度;采用Bazaz吞咽困难分级评估患者术后吞咽困难的发生率。术后12个月时采用颈椎正侧位X线及CT检查评估植骨融合情况,采用MRI检查评估临近节段退变情况。比较两组患者术中出血量、手术时间、手术前后JOA评分、Odom评级及VFSS中的椎前软组织厚度、术后患者吞咽困难发生率(Bazas评分)、椎体间融合率、邻近节段退变发生率。结果:手术前后两组患者的JOA评分、Odom功能评级差异比较无统计学意义(P0.05);两组患者术前VFSS中的椎前软组织厚度比较差异无统计学意义(P0.05);两组患者手术时间及术中出血量比较差异无统计学意义。两组患者VFSS中的椎前软组织厚度、吞咽困难发生率在术后第2天,术后3、6个月及末次随访时差异均有统计学意义(P0.05)。术后1年所有患者获植骨融合,两组融合率比较差异无统计学意义(P0.05)。A组8例(12.7%)出现邻近节段退变,B组19例(25%)出现临近节段退变,两组比较差异有统计学意义(P0.05)。结论:应用零切迹颈椎前路椎间融合固定系统和传统钛板联合cage融合内固定治疗单节段颈椎间盘突出症均可取得满意疗效,前者术后吞咽困难和临近节段退变发生率较低,中长期疗效有待进一步观察。     

Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure

Background  

The Cloward anterior interbody fusion is commonly performed for cervical disc herniation or spondylosis. In followup studies, various authors have noted clinically relevant adjacent-level degeneration. However, factors associated with adjacent-level degeneration are not well known.     

Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546]

Background  

Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation.     

Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone

Background  

In an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease.     

Does anterior lumbar interbody fusion promote adjacent degeneration in degenerative disc disease? A finite element study

Background  

The increase in the number of anterior lumbar interbody fusions being performed carries with it the potential for the long-term complication of adjacent segmental degeneration. While its exact mechanism remains uncertain, adjacent segment degeneration has become much more widespread. Using a nonlinear, three-dimensional finite element model to analyze and compare the biomechanical influence of anterior lumbar interbody fusion and lumbar disc degeneration on the superior adjacent intervertebral disc, we attempt to determine if anterior lumbar interbody fusion aggravates adjacent segment degeneration.     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

Remodeling of adjacent spinal alignments following cervical arthroplasty and anterior discectomy and fusion

Objective  

To evaluate the effects of cervical artificial disc replacement (ADR) and anterior discectomy and fusion (ACDF) on adjacent spinal alignments.     

Superiority of the Bryan<Superscript>®</Superscript> Disc Prosthesis for Cervical Myelopathy: A Randomized Study with 3-year Followup

Background  

The current standard of care for cervical myopathy is anterior discectomy and fusion (ACDF). Although well tolerated in the short term, this treatment might ultimately result in progressive degeneration of adjacent motion segments. Artificial disc arthroplasty offers the theoretical advantage of preservation of motion at the operative level with consequent stress reduction at adjacent levels.     

Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up

Background context

Anterior cervical discectomy and fusion using cervical plates has been seen as effective at relieving cervical radiculopathy and myelopathy symptoms. Although it is commonly used, subsequent disc degeneration at levels adjacent to the fusion remains an important problem. However, data on the frequency, impact, and predisposing factors for this pathology are still rare.

Purpose

To evaluate the incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies after anterior cervical discectomy and fusion using cervical plates and to analyze the efficacy of this surgical method over the long term, after a minimum follow-up period of 10 years.

Study design

Retrospective clinical study.

Patient sample

Our study was a retrospective analysis of 177 patients who underwent anterior cervical discectomy and fusion using cervical plates, with follow-up periods of at least 10 years (mean 16.2 years).

Outcome measures

Radiographic adjacent-segment pathology using plain radiographs and clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates.

Methods

We defined a new grading system of plain radiographic evidence of degenerative changes in adjacent discs after anterior cervical discectomy and fusion using cervical plates; Grade 0 is considered normal, and Grade V consists the presence of posterior osteophytes and a decrease in disc height to less than 50% of normal. The incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies were analyzed according to etiologies, number of fused segments, and plate-to-disc distance.

Results

Radiographic and clinical adjacent-segment pathologies were found in 92.1% and 19.2%, respectively, of patients. By etiology, clinical adjacent-segment pathology was observed in 13.5% of patients who had sustained trauma, 12.7% of those with disc herniation, and 33.3% of those with spondylosis. By number of fused segments, clinical adjacent-segment pathology was found in 13.2% of patients who underwent single-level fusion and in 32.1% of those who underwent multilevel fusion surgeries. Patients with a plate-to-disc distance of less than 5 mm, who had spondylosis, or who underwent multilevel fusion had a higher incidence of clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates than other groups did (p<.05). Of all patients, only 6.8% needed follow-up surgery.

Conclusions

We found that over the long term, at a minimum follow-up point of 10 years, a plate-to-disc distance of less than 5 mm, having spondylosis, and undergoing multilevel fusion were predisposing factors for the occurrence of clinical adjacent-segment pathology. Nevertheless, the incidence of clinical findings of adjacent-segment pathology was much lower than the incidence of radiographic findings. Also, the rate of follow-up surgery was low. Therefore, anterior cervical discectomy and fusion using cervical plates can be considered a safe and effective procedure.     

两种前路减压融合术治疗颈椎间盘突出症的比较

目的对前路颈椎间盘切除减压的碳纤维椎间融合器(cage)植入术与自体髂骨块植骨加钛板固定术治疗单节段颈椎间盘突出症(CDH)进行临床疗效及影像学评估。方法需要手术治疗的单节段CDH患者60例,其中前路减压cage植入术31例,自体髂骨块植骨加钛板固定术29例。术前、术后及随访期间摄X线片,比较两组病例的手术时间、术中出血量、术后并发症、症状改善率、融合时间、融合率、融合节段椎体间高度的维持情况。结果cage植入术较自体髂骨块植骨加钛板固定术手术时间短,出血少(P<0.01)。两组融合节段椎体间高度较术前均明显改善(P<0.01)。两组间症状改善率、融合率无统计学意义(P>0.05)。cage植入术较自体髂骨块植骨加钛板固定术并发症少。结论cage植入术和自体髂骨块植骨加钛板固定术都是前路减压治疗单节段CDH的重要而有效的方法。而cage植入术在减小手术创伤的同时,可以获得同样的临床效果,是治疗单节段CDH理想的术式之一。     

Anterior discectomy without interbody fusion for cervical disc herniation

Summary Between 1985 and 1990, 68 patients with cervical radiculopathy due to soft disc herniation were treated by anterior cervical discectomy without interbody fusion. Eleven patients were unavailable for follow-up examination. The mean follow-up was 23 months (range 12–54 months). Both clinical and radiographic follow-ups were done, and 92% of the patients was found to have excellent or good clinical results. Radiographic follow-up revealed that 34% had fused spontaneously and 66% developed fibrous healing of the disc space with an average range of mobility of 2.07 deg. All patients were shown to be stable on flexion-extension films. Complications included two transient CSF leaks. No neurologic deficits arose. One patient was reoperated and fused for intractable residual neck pain. We conclude that anterior cervical discectomy without interbody fusion is a simple, safe and effective procedure for patients with soft disc herniation.     

Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc herniation: a prospective multicenter study

Background  

Anterior decompression and fusion (ADF) has conventionally been used, with stable outcomes, for cervical myelopathy caused by soft disc herniation. However, complications related to bone grafting and recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of laminoplasty as an alternative has been sporadically reported, but no prospective study has been conducted to verify it. The purpose of this study was to determine whether laminoplasty is comparable for this condition.     

The Bryan cervical disc prosthesis. Preliminary clinical experience with nine implants

PURPOSE: After an anterior cervical discectomy, immobility at the fused level may increase stress on adjacent disc spaces and causes disc degeneration in 92% of the cases with clinical manifestations in 25.6% of the patients within 10 years. The cervical disk prosthesis may help to prevent this problem. The Bryan prosthesis (Medtronic Sofamor Danek) is currently available in France after a European pilot study. METHODS: Since January 2002, 8 patients (9 implants) (mean age: 35 years) were operated on with a prosthesis implantation for disc degeneration after an adjacent previous interbody fusion in 2 patients and for disc herniation or spondylosis in 6 patients. The prosthesis were implanted at the C4-C5 level (one patient), C5-C6 (four patients), and C6-C7 (four patients). Post-operative radiological evaluations with dynamic X-rays and clinical status (Odom questionnaire) were analyzed. RESULTS: Surgical procedures, which were longer than the classical technique, were uneventful. Radicular pain resolved after surgery with excellent results with the Odom's score. With a mean follow-up of 12 months, the prosthesis mobility was 8.9 degrees . But one fusion of an implant was encountered 6 months after implantation. CONCLUSIONS: The general follow-up for the Bryan(R) cervical disc prosthesis implantation is still too short (2 years) for a definitive evaluation. If clinical results on pain are as good as expected, long-term mobility of the prosthesis has to be checked, as it is the main advantage over classical anterior cervical discectomy with fusion. Patient selection has to be considered.     

颈椎前路减压人工颈椎间盘置换术与融合术治疗单节段颈椎间盘突出症的短期疗效比较

背景：颈前路椎间盘切除植骨融合术（ACDF）能够为有症状的颈椎病患者提供较好的治疗效果,但颈椎融合可导致相邻节段椎间盘内部应力增加,加速邻近节段椎间盘的退变。颈椎人工椎间盘置换术（ACDR）作为最具代表性的颈椎前路非融合技术,为颈椎间盘突出症的治疗提供了另外一种外科手段。目的：比较ACDR和ACDF治疗单节段颈椎间盘突出症的临床效果。方法：2009年1月至2012年2月,61例单节段颈椎间盘突出症患者接受Discover人工颈椎间盘置换手术（置换组,26例）或ACDF手术（融合组,35例）。分别在术前,术后1周,术后3、6、12及24个月对患者进行疼痛视觉模拟评分（VAS）、日本矫形外科协会（JOA）评分及影像学评估,同时记录患者并发症及二次手术情况。结果：最终,52例患者（融合组29例,置换组23例）获得平均15.3个月（12-24个月）随访。两组患者术后各随访时间点的颈痛、上肢痛VAS和JOA评分,较术前均有改善（P〈0.05）,但两组间无显著统计学差异（P〉0.05）。置换组术后手术节段及邻近节段屈伸活动度与术前比较无统计学差异（P〉0.05）。融合组融合成功率为90.5%。置换组中2例患者术后6个月时假体有〈3 mm的前移,l例术后发生脑脊液漏。融合组中1例患者发生邻椎病并接受二次手术治疗。结论：单节段Discover人工颈椎间盘置换术和ACDF均可明显缓解颈椎间盘突出症患者的症状。间盘置换还能减少手术邻近节段代偿活动度的增加,有望预防相邻节段退变的发生。     

内窥镜下颈椎间盘切除及椎体间植骨融合术

目的:探讨内窥镜下颈椎间盘切除及椎体间植骨融合术治疗颈椎疾患的疗效。方法:经内窥镜颈椎间盘切除及植骨术治疗颈椎疾病25例,包括脊髓型颈椎病17例,神经根型颈椎病3例,交感型颈椎病2例及外伤性颈椎间盘突出症3例。结果:本组患者颈部手术出血平均80ml,18例获10~46个月(平均27个月)随访,植骨全部融合,脊髓和神经根压迫症状改善满意,除1例出现术后植骨块移位外,未见其它合并症。结论:经内窥镜下颈椎间盘切除及植骨融合术是一种创伤小、安全、可靠的手术技术,适合于颈椎间盘突出症及部分颈椎病的治疗。     

Anterior cervical discectomy without interbody fusion

BACKGROUND: The use of an interbody bone graft during anterior cervical discectomy remains a controversial topic. This study presents the outcome of 64 consecutive patients who underwent anterior cervical discectomy without an interbody fusion. METHODS: Sixty-four consecutive patients underwent anterior cervical discectomy without interbody fusion by one surgeon at Indiana University School of Medicine between April 1994 and February 1998. A retrospective analysis of these cases was performed to evaluate outcome of this procedure. Outcome was determined using the criteria of Odom and Finney. RESULTS: In our series of patients, the mean age was 49.4 years, and the mean time of follow-up was 8.5 months. The presentation was as follows: 69% radiculopathy alone, 23% combined myelopathy and radiculopathy, and 8% myelopathy. Although 31% of the patients had symptoms for more than 1 year, the mean duration of symptoms of the remainder of patients was 3.2 months. The majority of patients had single-level disease (77%); however, 25% underwent 2 level discectomies, and 2% underwent 3 level discectomies. Twenty-four patients (38%) had soft disc herniation, and 40 patients (62%) had hard disc herniation. Of the 64 patients, 91% had either good or excellent outcomes, 9% had satisfactory outcomes, and none had a poor result. Ninety-six percent of the patients with soft disc herniation had good or excellent outcomes, whereas 88% of the patients with hard disc had good or excellent outcomes (p = 0.217). Ninety-one percent of the patients who worked before surgery returned to work after their operation. None of the patients required reoperation at the operative level or exhibited instability at the operative level. Postoperative complications included transient intrascapular pain (13%), kyphotic deformity (3%), transient vocal cord paralysis (2%), and temporary dysphagia (2%). No significant difference in age or outcome existed when comparing males to females. CONCLUSION: Satisfactory results can be attained by discectomy without an interbody fusion in the surgical management of cervical disc disease.     

Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial

Background  

The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD). This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation.     

Long-term follow-up after interbody fusion of the cervical spine

The aim of this work was to add to the body of data on the frequency and severity of degenerative radiographic findings at adjacent levels after anterior cervical interbody fusion and on their clinical impact and to contribute to the insights about their pathogenesis. One hundred eighty patients who were treated by anterior cervical interbody fusion and who had a follow-up of >60 months were clinically and radiologically examined by independent investigators. For all patients, the long-term Odom score was compared with the score as obtained 6 weeks after surgery. For myelopathic cases, both the late Nurick and the Odom score were compared with the initial postoperative situation. For the adjacent disc levels, a radiologic "degeneration score" was defined and assessed both initially and at long-term follow-up. At late follow-up after anterior cervical interbody fusion, additional radiologic degeneration at the adjacent disc levels was found in 92% of the cases, often reflecting a clinical deterioration. The severity of this additional degeneration correlated with the time interval since surgery. The similarity of progression to degeneration between younger trauma patients and older nontrauma patients suggests that both the biomechanical impact of the interbody fusion and the natural progression of pre-existing degenerative disease act as triggering factors for adjacent level degeneration.     

Full-endoscopic technique for anterior cervical discectomy and interbody fusion: 5-year follow-up results of 67 cases

With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362–368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique were followed for at least 5 years. We reviewed the clinical and radiographic records of these patients. The postoperative radiographic measures accessed were the anterior intervertebral height (AIH) and the lordosis angle (LDA). Clinical outcomes were determined using the previously validated Japanese Orthopaedic Association (JOA) and the pain visual analog scale (VAS). Patients included had a minimal follow-up period of 5 years and based on the outcomes criteria (JOA, VAS), 86.6% of patients reported excellent or good results. The AIH increased on average 18.7% of the original height (p < 0.01), and the LDA were more physiologic at final follow-up. Of the 67 cases, there was no segmental instability, and the bone fusion rate was 100%. One patient required revision open ACDF due to adjacent segment disc herniation 6 years postoperatively. There were no intraoperative complications, dysphasia or esophageal injury in this study group. It indicated endoscopic technique for ACDF can obtain satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. Compared with a traditional approach, this technique may be associated with less morbidity while improving cosmesis and postoperative recovery. Prospective randomized control trials are needed to directly compare these two procedures.