BACKGROUND Cervical degenerative disc(CDD)disease is a common type of spondylosis.Although anterior cervical discectomy and fusion(ACDF)is the preferred treatment for CDD disease,internal fixation with a titanium plat...BACKGROUND Cervical degenerative disc(CDD)disease is a common type of spondylosis.Although anterior cervical discectomy and fusion(ACDF)is the preferred treatment for CDD disease,internal fixation with a titanium plate may cause various complications.The invention of the ACDF with a self-locking fusion cage(ROI-C)has effectively decreased the incidence of postoperative complications.AIM To observe the outcomes of CDD disease treated by ACDF with a ROI-C.METHODS Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included.They were divided into two groups(control group and observation group,n=45 in each)using a random number table.Patients in the control group received ACDF plus internal fixation with a titanium plate.Those in the observation group received ACDF+ROI-C placement.The two groups of patients were compared in terms of surgical parameters,pain,cervical spine function,range of motion,and complications.RESULTS The two groups of patients showed no significant differences in surgical time,blood loss,drainage volume,and length of hospital stay(P>0.05).No significant differences in the visual analogue scale(VAS),Japanese Orthopedic Association(JOA),and neck disability index(NDI)scores were observed between the two groups before surgery(P>0.05).The VAS and NDI scores in the observation group were considerably lower than those in the control group after surgery;however,the JOA scores in the observation group were significantly higher than those in the control group(P<0.05).No significant differences were observed in cervical disc height and the range of motion of the superior or inferior adjacent vertebrae between the two groups before surgery(P>0.05).The disc height in the observation group was larger than that in the control group after surgery.The range of motion of both the superior and inferior adjacent vertebrae was significantly smaller in the observation group than in the control group(P<0.05).The incidence of complications was only 2.22% in the observation group compared to 15.56% in the control group,and the difference was statistically significant(P<0.05).CONCLUSION Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.展开更多
Introduction: Cervical radiculopathy is caused by either cervical disc herniation or bone spurs due to cervical spine degeneration. It is common in middle aged and elderly patients. Those patients who are refractory t...Introduction: Cervical radiculopathy is caused by either cervical disc herniation or bone spurs due to cervical spine degeneration. It is common in middle aged and elderly patients. Those patients who are refractory to conservative treatment are candidates for surgical management. The surgical approaches for cervical radiculopathy are either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). In spite of many reports on ACDF and PCF, only a few studies directly compare the outcomes of both techniques. Purpose: To compare anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for the treatment of cervical radiculopathy, regarding the surgical, clinical and radiological outcomes. Patient and methods: This is a prospective randomized controlled clinical study carried on 44 patients with unilateral cervical radiculopathy. They are divided into 2 groups;group (A) included 23 patients who underwent ACDF and group (B) included 21 patients who underwent PCF, with 1 year follow up. The patient age, sex, clinical manifestations, surgical outcomes as number of cervical level, operative time, blood loss, complications and length of hospital stay were recorded. Visual analogus scale (VAS) and neck disability index (NDI) were used for evaluation of clinical outcomes. Postoperative imaging was done after 1 year to detect instability or adjacent level degeneration. Chi-square and unpaired T-test were used to compare the mean values of both groups. Results: The mean age was nearly 45 years for both groups. C5-6 ACDF was the most common level in group (A), while C6-7 PCF was the most frequent operated level in group (B). PCF group had less operative time, blood loss and length of hospital stay than ACDF group. Clinical improvement of the mean values of VAS and NDI were more pronounced in PCF group as compared to ACDF group with statistically significant difference. No cases of cervical instability were recorded during the period of follow up. Conclusion: Posterior cervical foraminotomy is a safe and effective technique for the treatment of cervical radiculopathy as compared to anterior cervical discectomy and fusion. PCF has a shorter operative time, less hospital stay and better clinical outcome.展开更多
BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 a...BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 after surgery.By sharing our experience with this case,we hope to provide new information about stroke after anterior cervical surgery.CASE SUMMARY We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago.The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery.Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery.With the consent of his family,the thrombus was removed and a vascular stent was implanted through an interventional operation.Forty days later,the patient was transferred to a rehabilitation hospital for further treatment.He had normal consciousness but slurred speech at the 1-year follow-up evaluation.The motor and sensory functions of his hemiplegic limbs partially recovered.CONCLUSION This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period.Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.展开更多
Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervicaldisc r...Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervicaldisc replacement (A group) ,and展开更多
Background: Multiple level anterior cervical discectomy and fusion (ACDF) is indicated for those who suffer from multilevel stenosis or compression of the spinal canal. It was reported that this intervention would unf...Background: Multiple level anterior cervical discectomy and fusion (ACDF) is indicated for those who suffer from multilevel stenosis or compression of the spinal canal. It was reported that this intervention would unfortunately lead to a loss of normal cervical range of motion (CROM). Although, fewer studies have demonstrated the exact impact of the procedure on CROM. In our study, short and midterm postoperative CROM was described. Methods: Ninety patients who underwent ACDF were followed up postoperatively for at least 3 months. Active CROM was measured in all patients preoperatively and in postoperative follow-ups by cervical spine X-rays in lateral dynamic view using Cobb’s angle method. Results: Unfortunately, postoperative CROM was significantly diminished. At the short-term (3 months) follow-up there was a great limitation in CROM. While an obvious increase in CROM at the midterm (6 months) follow-up was observed in flexion especially. The reduction in global ROM (calculated as preoperative global ROM – 6 months postoperative ROM) was 4.1 and the reduction rate (calculated as reduction ROM divided by preoperative ROM) was 9.5%. The recovery ROM (calculated as 6 months postoperative ROM – 1 month postoperative ROM) was 8.2. The recovery rate (calculated as recovery ROM divided by 1 month postoperative ROM) was 26.5%. Conclusion: Active CROM following multiple level ACDF was obviously diminished. The most affected motion after surgery was flexion. It was noticed that at the short-term follow-up CROM would be more limited while after further follow up CROM was obviously improved even in neck flexion motion.展开更多
目的观察显微镜辅助下颈椎前路椎间盘切除融合内固定术(anterior cervical discectomy and fusion,ACDF)联合高速磨钻治疗孤立型颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效及有效性。方法回...目的观察显微镜辅助下颈椎前路椎间盘切除融合内固定术(anterior cervical discectomy and fusion,ACDF)联合高速磨钻治疗孤立型颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效及有效性。方法回顾性分析2018年1月~2020年12月本院骨科诊治的孤立型后纵韧带骨化症患者28例,均在显微镜辅助下联合高速磨钻行颈椎前路ACDF手术,其中男13例,女15例;年龄40~65岁;C_(3-4)3例,C_(4-5)8例,C_(5-6)7例,C_(6-7)10例。对患者术前及术后1年进行相关指标评价,同时观察患者术后出现的相关并发症。结果所有患者均获得随访,术后1年JOA评分、NDI评分、颈椎VAS评分均较术前显著改善,差异有统计学意义(P<0.05)。3例患者因后纵韧带骨化和硬膜黏连严重,用超声骨刀将其打薄后漂浮,未行彻底切除。术后患者未出现喉返神经、喉上神经损伤,无脊髓损伤及脑脊液漏。结论显微镜辅助下ACDF联合高速磨钻治疗孤立型后纵韧带骨化症,可较好地改善患者神经功能,取得较好的临床疗效,术中操作安全性高。展开更多
目的:探究中药联合颈前路椎间盘切除减压融合术治疗神经根型颈椎病的临床疗效,术后使用中药是否能够促进患者康复。方法:回顾性分析2019年10月—2022年2月在中日友好医院脊柱外科行颈前路椎间盘切除减压融合术的58例神经根型颈椎病患者...目的:探究中药联合颈前路椎间盘切除减压融合术治疗神经根型颈椎病的临床疗效,术后使用中药是否能够促进患者康复。方法:回顾性分析2019年10月—2022年2月在中日友好医院脊柱外科行颈前路椎间盘切除减压融合术的58例神经根型颈椎病患者。58例患者被分为单纯手术组和手术联合中药组,其中单纯手术组32例,手术联合中药组26例。记录并分析手术时间、术中出血量、术后并发症情况及术前与术后不同时间点纳入患者的疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)。结果:所有手术均顺利完成且患者均完成术后12个月内的随访。单纯手术组和手术联合中药组的VAS评分在术后1个月、3个月(3.00±0.75 vs 2.00±1.00;2.00±1.00 vs 2.00±1.00)差异有统计学意义(P<0.05);NDI评分在术后3个月、6个月(15.00±3.00 vs 13.00±3.00;13.94±1.90 vs 12.50±3.00)差异有统计学意义(P<0.05)。结论:颈前路椎间盘切除减压融合术可解除患者颈神经受压状态,术后联合使用中药可以改善患者症状,缓解术后疼痛,促进神经功能恢复。展开更多
文摘BACKGROUND Cervical degenerative disc(CDD)disease is a common type of spondylosis.Although anterior cervical discectomy and fusion(ACDF)is the preferred treatment for CDD disease,internal fixation with a titanium plate may cause various complications.The invention of the ACDF with a self-locking fusion cage(ROI-C)has effectively decreased the incidence of postoperative complications.AIM To observe the outcomes of CDD disease treated by ACDF with a ROI-C.METHODS Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included.They were divided into two groups(control group and observation group,n=45 in each)using a random number table.Patients in the control group received ACDF plus internal fixation with a titanium plate.Those in the observation group received ACDF+ROI-C placement.The two groups of patients were compared in terms of surgical parameters,pain,cervical spine function,range of motion,and complications.RESULTS The two groups of patients showed no significant differences in surgical time,blood loss,drainage volume,and length of hospital stay(P>0.05).No significant differences in the visual analogue scale(VAS),Japanese Orthopedic Association(JOA),and neck disability index(NDI)scores were observed between the two groups before surgery(P>0.05).The VAS and NDI scores in the observation group were considerably lower than those in the control group after surgery;however,the JOA scores in the observation group were significantly higher than those in the control group(P<0.05).No significant differences were observed in cervical disc height and the range of motion of the superior or inferior adjacent vertebrae between the two groups before surgery(P>0.05).The disc height in the observation group was larger than that in the control group after surgery.The range of motion of both the superior and inferior adjacent vertebrae was significantly smaller in the observation group than in the control group(P<0.05).The incidence of complications was only 2.22% in the observation group compared to 15.56% in the control group,and the difference was statistically significant(P<0.05).CONCLUSION Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.
文摘Introduction: Cervical radiculopathy is caused by either cervical disc herniation or bone spurs due to cervical spine degeneration. It is common in middle aged and elderly patients. Those patients who are refractory to conservative treatment are candidates for surgical management. The surgical approaches for cervical radiculopathy are either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). In spite of many reports on ACDF and PCF, only a few studies directly compare the outcomes of both techniques. Purpose: To compare anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for the treatment of cervical radiculopathy, regarding the surgical, clinical and radiological outcomes. Patient and methods: This is a prospective randomized controlled clinical study carried on 44 patients with unilateral cervical radiculopathy. They are divided into 2 groups;group (A) included 23 patients who underwent ACDF and group (B) included 21 patients who underwent PCF, with 1 year follow up. The patient age, sex, clinical manifestations, surgical outcomes as number of cervical level, operative time, blood loss, complications and length of hospital stay were recorded. Visual analogus scale (VAS) and neck disability index (NDI) were used for evaluation of clinical outcomes. Postoperative imaging was done after 1 year to detect instability or adjacent level degeneration. Chi-square and unpaired T-test were used to compare the mean values of both groups. Results: The mean age was nearly 45 years for both groups. C5-6 ACDF was the most common level in group (A), while C6-7 PCF was the most frequent operated level in group (B). PCF group had less operative time, blood loss and length of hospital stay than ACDF group. Clinical improvement of the mean values of VAS and NDI were more pronounced in PCF group as compared to ACDF group with statistically significant difference. No cases of cervical instability were recorded during the period of follow up. Conclusion: Posterior cervical foraminotomy is a safe and effective technique for the treatment of cervical radiculopathy as compared to anterior cervical discectomy and fusion. PCF has a shorter operative time, less hospital stay and better clinical outcome.
基金Capital’s Funds for Health Improvement and Research,No.2020-2-4091.
文摘BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 after surgery.By sharing our experience with this case,we hope to provide new information about stroke after anterior cervical surgery.CASE SUMMARY We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago.The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery.Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery.With the consent of his family,the thrombus was removed and a vascular stent was implanted through an interventional operation.Forty days later,the patient was transferred to a rehabilitation hospital for further treatment.He had normal consciousness but slurred speech at the 1-year follow-up evaluation.The motor and sensory functions of his hemiplegic limbs partially recovered.CONCLUSION This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period.Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.
文摘Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervicaldisc replacement (A group) ,and
文摘Background: Multiple level anterior cervical discectomy and fusion (ACDF) is indicated for those who suffer from multilevel stenosis or compression of the spinal canal. It was reported that this intervention would unfortunately lead to a loss of normal cervical range of motion (CROM). Although, fewer studies have demonstrated the exact impact of the procedure on CROM. In our study, short and midterm postoperative CROM was described. Methods: Ninety patients who underwent ACDF were followed up postoperatively for at least 3 months. Active CROM was measured in all patients preoperatively and in postoperative follow-ups by cervical spine X-rays in lateral dynamic view using Cobb’s angle method. Results: Unfortunately, postoperative CROM was significantly diminished. At the short-term (3 months) follow-up there was a great limitation in CROM. While an obvious increase in CROM at the midterm (6 months) follow-up was observed in flexion especially. The reduction in global ROM (calculated as preoperative global ROM – 6 months postoperative ROM) was 4.1 and the reduction rate (calculated as reduction ROM divided by preoperative ROM) was 9.5%. The recovery ROM (calculated as 6 months postoperative ROM – 1 month postoperative ROM) was 8.2. The recovery rate (calculated as recovery ROM divided by 1 month postoperative ROM) was 26.5%. Conclusion: Active CROM following multiple level ACDF was obviously diminished. The most affected motion after surgery was flexion. It was noticed that at the short-term follow-up CROM would be more limited while after further follow up CROM was obviously improved even in neck flexion motion.
文摘目的观察显微镜辅助下颈椎前路椎间盘切除融合内固定术(anterior cervical discectomy and fusion,ACDF)联合高速磨钻治疗孤立型颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效及有效性。方法回顾性分析2018年1月~2020年12月本院骨科诊治的孤立型后纵韧带骨化症患者28例,均在显微镜辅助下联合高速磨钻行颈椎前路ACDF手术,其中男13例,女15例;年龄40~65岁;C_(3-4)3例,C_(4-5)8例,C_(5-6)7例,C_(6-7)10例。对患者术前及术后1年进行相关指标评价,同时观察患者术后出现的相关并发症。结果所有患者均获得随访,术后1年JOA评分、NDI评分、颈椎VAS评分均较术前显著改善,差异有统计学意义(P<0.05)。3例患者因后纵韧带骨化和硬膜黏连严重,用超声骨刀将其打薄后漂浮,未行彻底切除。术后患者未出现喉返神经、喉上神经损伤,无脊髓损伤及脑脊液漏。结论显微镜辅助下ACDF联合高速磨钻治疗孤立型后纵韧带骨化症,可较好地改善患者神经功能,取得较好的临床疗效,术中操作安全性高。
文摘目的:探究中药联合颈前路椎间盘切除减压融合术治疗神经根型颈椎病的临床疗效,术后使用中药是否能够促进患者康复。方法:回顾性分析2019年10月—2022年2月在中日友好医院脊柱外科行颈前路椎间盘切除减压融合术的58例神经根型颈椎病患者。58例患者被分为单纯手术组和手术联合中药组,其中单纯手术组32例,手术联合中药组26例。记录并分析手术时间、术中出血量、术后并发症情况及术前与术后不同时间点纳入患者的疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)。结果:所有手术均顺利完成且患者均完成术后12个月内的随访。单纯手术组和手术联合中药组的VAS评分在术后1个月、3个月(3.00±0.75 vs 2.00±1.00;2.00±1.00 vs 2.00±1.00)差异有统计学意义(P<0.05);NDI评分在术后3个月、6个月(15.00±3.00 vs 13.00±3.00;13.94±1.90 vs 12.50±3.00)差异有统计学意义(P<0.05)。结论:颈前路椎间盘切除减压融合术可解除患者颈神经受压状态,术后联合使用中药可以改善患者症状,缓解术后疼痛,促进神经功能恢复。
