颈椎人工间盘置换与前路减压融合修复单节段颈椎间盘突出症：3年随访

Artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation: a 3-year follow-up

背景:前路减压融合是修复颈椎退行性椎间盘突出症的良好选择,但有报道显示融合可使颈椎邻近阶段的运动受到影响。人工椎间盘置换不仅能发挥缓解颈椎病神经症状和体征的作用,还能保持颈椎的稳定和节段活动,减少邻近节段继发性退变。而目前两种方法应用于颈椎退行性椎间盘突出症仍存在争议。目的:探讨颈椎人工间盘置换与前路减压融合修复单节段颈椎间盘突出症的近期效果。方法:纳入因颈椎间盘突出导致单节段神经根型或脊髓型颈椎病而需手术治疗并且获得了3个月以上随访的48例患者进行回顾性分析。根据修复方案分为两组,置换组21例采用Prestige LP人工颈椎间盘置换,融合组27例采用强生椎间融合器或异体腓骨环行椎间盘融合。患者治疗后1周及3,6,12,24,36个月医院门诊随访,记录随访过程中并发症发生情况。采用颈部和上肢疼痛目测类比评分评估患者的疼痛情况,治疗效果评价采用日本骨科学会(JOA)评分法,治疗后临床症状改善和日常功能状态采用颈椎功能障碍指数评价。结果与结论:末次随访融合组融合率为93%(25/27)。组内比较,治疗后1周及末次随访时,颈部及上肢目测类比评分、颈椎功能障碍指数均低于治疗前,J OA评分高于治疗前(P<0.05);末次随访时颈部及上肢目测类比评分、颈椎功能障碍指数均低于治疗后1周,JOA评分高于治疗后1周(P<0.05)。治疗后各时间点两组上述指标差异无显著性意义(P>0.05)。置换组治疗后颈椎活动度及手术节段活动度明显高于融合组,差异有显著性意义(P<0.05)。两组均未出现严重并发症,两组患者并发症发生率差异无显著性意义(P>0.05)。提示颈椎人工间盘置换与前路减压融合修复单节段颈椎间盘突出症在患者症状缓解方面效果相同。人工椎间盘置换相对于融合技术具有保持颈椎稳定和置换节段活动度的优势。

BACKGROUND： Anterior cervical discectomy and fusion surgery is a good choice for repair of degenerative cervical disc herniation, but it is reported that fusion can affect the exercise of cervical neighboring stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration.These two methods which applied in cervical degenerative intervertebral disc herniation still remain controversial. OBJECTIVE： To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS： Totally 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month follow-up were included and retrospectively analyzed. These patients were divided into replacement group （n=21） and fusion group （n=27） according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or allogeneic fibularing. They were followed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the follow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association （JOA） score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION： During the final follow-up, the fusion rate in fusion group was 93% （25/27）. Comparisons between groups： at the 1 week and final follow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were all lower than those before treatment; the Japanese Orthopaedic Association scores were higher than those before treatment （P 〈 0.05）. In the final follow-up, the visual analog scale scores of neck and upper limbs and cervical dysfunction index were all lower than those after one week of treatment, and the Japanese Orthopaedic Association scores were higher than those after one week of treatment （P 〈 0.05）. There were no significant differences in the above indicators at each time point between these two groups （P 〉 0.05）. The cervical activity and surgical segmental motion after cervical disc replacement were significantly higher than those in the fusion group; the difference was statistically significant （P 〈 0.05）. There were no serious complications in these two groups. There was no significant difference in the incidence of complications between these two groups （P 〉 0.05）. These results suggest that the artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single cervical disc herniation have the same effect in terms of patients＇ symptoms mitigation. With respect to fusion technique, artificial disc replacement surgery has the advantage of maintaining cervical stability and activities of replacement segments.