Advances in Cervical Artificial Disc Replacement for Cervical Spondylosis

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.

Application of a modified surgical position in anterior approach for total cervical artificial disc replacement

BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.

Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients＇ ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months （with a mean of 5.2 months）. Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130±50 rain and the time of two-level surgery was 165±53 min on average （from skin incision to skin suturing）. Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores （JOA scores） increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68° （3.6°-6.1°） in flexion and extension position and 3.51 ° （2.5°-4.6°）, 3.42° （2.6°-4.3°） in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm） in 2 of 14 levels and between 1.5 mm and 3 mm） in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

Lumbar and cervical viscoelastic disc replacement:Concepts and current experience

The ideal lumbar and cervical discs should provide six degrees of freedom andtri-planar (three-dimensional) motion. Although all artificial discs are intended toachieve the same goals, there is considerable heterogeneity in the design oflumbar and cervical implants. The “second generation total disc replacements”are non-articulating viscoelastic implants aiming at the reconstruction ofphysiologic levels of shock absorption and flexural stiffness. This review aims togive an overview of the available implants detailing the concepts and thefunctional results experimentally and clinically. These monobloc prostheses raisenew challenges concerning the choice of materials for the constitution of theviscoelastic cushion, the connection between the components of the internalstructure and the metal endplates and even the bone anchoring mode. Newobjectives concerning the quality of movement and mobility control must bedefined.

Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage

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.

Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages

Background: cervical spondylotic myelopathy is a common health problem that neurosurgeons face in Egypt. The aim of this study is to evaluate the efficacy of PEEK cage only in 4 levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Methods: this prospective study on 28 patients with cervical spondylotic myelopathy (CSM) over a period of 3 years (between April 2012 and April 2015) with mean period of follow up 30 months. We have done anterior cervical discectomy with fixation by cage only for all cases with perioperative assessment and scoring clinically and radiologically (Japanese Orthopaedic Association [JOA] scores, Visual Analogue Scale [VAS] scores for assessment of neck and arm pain, perioperative parameters (hospital stay, blood loss, operative time), the European Myelopathy Scoring (EMS) and Odom’s criteria, and the incidence of complication,post spinal surgery pain assessment). Results: clinical outcome was excellent (28.55), good (50%) and fair (21.5) according to Odom criteria. The European Myelopathy Scoring (EMS), improved from 10 to 16. The mean JOA score improved from 10.1 ± 2.1 to 14.2 ± 2.3. Fusion failure had been seen in 4 patients in one level for each secondary to anterior displacement of the cage with no other major complications. Conclusion: 4 levels anterior cervical discectomy with PEEK cage only is an effective, save and less costly with less post operative complication and hospital stay and less post spinal surgery pain.

Percutaneous Cervical Disecectomy for Treating Cervical Disc Herniation──A report of 12 Cases

cases of percutaneous cervical discectomy (PCD) were performed using a set of nucleotome system. 9 patients showed good to excellent results in 12 cases,without any significant complications. The safe space of percutaneous puncture was suggested, e. g., the space between the carotid vessels and trachea.The procedures of PCD were introduced. The indications and contraindications of PCD and its mechanism,efficacy and prevention of complications were discussed.

Cervical Disc Replacement: A Systematic Review of Medline Indexed Literature

Anterior Cervical Discectomy and Fusion (ACDF) currently remains as the gold standard treatment for cervical disc herniation and Degenerative Disc Disease (DDD) refractory to conservative management. Even though anterior cervical fusion provides excellent clinical results, it has been implicated in abnormal kinematic strain on adjacent disc level resulting in symptomatic adjacent segment disease. Anterior cervical disc replacement (ACDR) is an alternative procedure to anterior cervical discectomy and fusion. The aims of cervical disc replacement were to preserve the motion at the index level and to protect the adjacent levels from accelerated symptomatic degeneration. The aim of this systematic review was to evaluate the outcomes of cervical disc replacement published in MEDLINE indexed literature. A literature search was carried out in medical electronic database MEDLINE. Keywords used for the search were Cervical vertebrae, Cervical spine, Neck, Intervertebral disc, Total disc replacement, Arthroplasty, Replacement, Treatment outcome. Two authors reviewed titles and abstracts of all two hundred and thirty six hits. The articles that satisfied the inclusion criteria were critically appraised while remaining articles were discarded. Anterior cervical disc replacement is a relatively new technology in spinal surgery. There are several short and intermediate term follow-up studies to prove the safety and efficacy of ACDR with satisfactory clinical and radiological outcomes. More intermediate to long-term follow-up studies are needed to prove the safety and efficacy of ACDR.

CLINICAL COMPARISION OF THE TREATMENT OF CERVICAL PROLAPSE OF INTERVERTEBRAL DISC BY USING CAGE OR TITANIUM PLATE

Objective To compare the clinical effects of treating cervical prolapse of intervertebral disc by using Solis cage, titanium cage and autogenous iliac crest graft (AICG) combined with titanium plate. Methods 64 cases of cervical prolapse of intervertebral disc were analyzed retrospectively. All the patients were followed up for about one year. Group A is composed of 20 patients (30 intervertebral spaces) treated with microdiscectomy and Solis cage fusion; group B is composed of 21 patients(22 intervertebral spaces) treated with titanium cage and group C is involved of 23 patients(28 intervertebral spaces) which were dealt with AICG combined with titanium plate. The differences in the total X ray exposure time, time working on iliac bone, incidence of complications, fusion rate, incidence of JOA score recovery rate more than 50% and rehabilitation time of the three groups are analyzed. Results All indexes from group A and B were more satisfactory than those from group C (P<0.05). The statistic analysis results of the incidence of complications of cervical part, rehabilitation time in group A are 5.0±1.8, 5.1±1.2; and that is 14.3±2.6, 7.5 ±1.6 and 26.1±6.2, 8.6±2.3 in group B and group C respectively. There is significant difference between group A and group B on the incidence of complications of cervical part and rehabilitation time (P<0.05). Results of the incidence of JOA score recovery rate >50% in group A(95.8±3.2) was more satisfactory than that in group B(93.6±2.9), while there was no statistical difference between group A and group B (P>0.05). Conclusion The Solis cage is better in treating the cervical prolapse of intervertebral disc than other ways. Also, it makes the operation easier, rehabilitation time shorter, and it causes fewer complications.

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery:Four case reports

BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

Conventional versus minimally-invasive cervical discectomy for treatment of severe degenerative disease at C5-C6: a biomechanical comparison using a model of the full cervical spine and finite element analysis

The purpose of this study was to determine the dif-ferences in biomechanical responses of tissues in the cervical spine when pain and other problems secon-dary to severe disc degeneration disease are surgi-cally treated by conventional discectomy (CONDIS) compared to minimally-invasive discectomy (MIVDIS). A validated three-dimensional model of an intact, healthy, adult full cervical spine (C1-C7) (INT) was constructed. This model was then modified to create two models, one simulating each of the above-men-tioned two techniques for discectomy of the severely degenerated C5-C6 disc. For each of these three models, we used the finite element analysis method to obtain three biomechanical parameters at various tissues in the model, under seven different physio-logically relevant loadings. For each of the biome-chanical parameters, the results were expressed as relative change in its value when a specified combi-nation of simulated discectomy model and applied loading was used, with respect to the corresponding value in the intact model. We then computed the value of a composite biomechanical performance in-dex (CBPI) for CONDIS and MIVDIS models, with this value incorporating all of the aforementioned relative changes. We found that CBPI was marginally lower for MIVDIS model. This trend is the same as that reported for the relative complications rate and outcome measures following conventional and mini-mally-invasive discectomies in the lumbar spine. From a healthcare perspective, one implication of our finding is that minimally-invasive cervical discectomy should be considered an attractive option provided that detailed patient selection criteria are clearly de-fined and strictly followed.

Lumbar Facet Cyst Causing S1 Radiculopathy with Concomittent Acute on Chronic Cervical Prolapse Intervertebral Disc, a Rare Case Report

Tandem spinal stenosis is described as concurrent symptomatic cervical and lumbar spinal stenosis. The clinical presentation includes neurogenic claudication, gait disturbance, myelopathy and polyradicuopathy in both upper and lower limbs. A 43-year-old female presented with predominant low back pain with right S1 radiculopathy leading to diagnosis of synovial facet cyst of lumbar spine. She was managed surgically after medical treatment failed. After 1 week post operatively, she presented with severe neck pain with left radiculopathy. MRI revealed acute on chronic cervical prolapsed intervertebral disc, cervical decompression surgery proceeded. Post operative improvement was noted on follow up. We report a case of tandem spinal stenosis, which both of the pathologies were managed with endoscopic approach.

Effects of acupuncture on expression of VEGF, PLA2 and PGE2 and extracellular matrix collagen and metabolic enzymes in the intervertebral disc of rats with cervical disc degeneration

Objective: The aim of this study was to investigate the effects of probe puncture on the expression of VEGF, PLA2 and PGE2 and extracellular matrix collagen and metabolic enzymes in the intervertebral disc of rats with cervical disc degeneration. Methods: Rats were randomly assigned to the following three groups (n = 25 per group): sham operation group (cut neck and then suture), model group (treated by modeling), and acupuncture treatment group (continuous daily) 30 minutes, complete course of treatment consisted of 14 days, 2 days between two courses);mRNA expression levels of VEGF, PLA2 and PGE2 were analyzed by qRT-PCR;protein levels of VEGF, PLA2 and PGE2 proteins were determined by Western blotting;Immunohistochemical staining was used to detect type I and type II collagen;TNF-α, IL-1β, MMP-1 and MMP-3 levels were detected by enzyme-linked immunosorbent assay;TUNEL assay was used to evaluate acupuncture treatment for cervical disc degeneration The effect of apoptosis. Results: The expression levels of VEGF, PLA2 and PGE2 mRNA and protein in the model group were higher than those in the sham operation group, while the acupuncture treatment group reduced the expression levels of VEGF, PLA2 and PGE2 mRNA and protein in the model group (P<0.05). The type I collagen was positively correlated with disc degeneration, and type II collagen was negatively correlated with disc degeneration. In the model group (0.18±0.05, 0.11±0.03), the expression level of type I collagen was higher than that of the sham operation group (0.12±0.03), the expression level of type II collagen was decreased (0.19±0.04), and the acupuncture treatment group was able to restore the model. Collagen levels of group I (0.14±0.03) and type II (0.17±0.03) were different between the three groups (P<0.05). Compared with the sham operation group, the model group was TNF-α, IL-1β, The expression levels of MMP-1 and MMP-3 were increased, while the acupuncture treatment group reduced the expression levels of TNF-α, IL-1β, MMP-1 and MMP-3 in the model group (P<0.05). The nuclear membrane of the model group was destroyed, the nucleus became denser, and the cells in the acupuncture treatment group showed a relatively intact nuclear membrane. The number of TUNEL-positive cells in the model group (131.17±12.15) was increased compared with the sham-operated group (64.53±8.73). Compared with the model group, the number of TUNEL-positive cells in the acupuncture treatment group decreased (P<0.05). Conclusion: Acupuncture can reduce the expression of type I collagen and metabolic enzymes in VEGF, PLA2 and PGE2 and extracellular matrix of cervical intervertebral disc degeneration, and increase the expression of type II collagen.

Mid-term outcomes of Bryan cervical disc arthroplasty versus anterior cervical discectomy and fusion for cervical spondylopathy

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

单节段Mobi-C人工间盘置换与ROI-C颈椎前路融合后颈椎矢状位参数的变化

背景:前期研究显示,双节段颈椎间盘置换对于颈椎矢状位参数有明显改善,且优于双节段ROI-C融合器,但不同手术节段的颈椎矢状位参数存在差异。目的:研究单节段Mobi-C人工颈椎间盘置换与ROI-C颈椎前路融合术后颈椎矢状位参数的差异。方法:回顾性分析2018年1月至2020年2月于北京中医药大学东直门医院就诊的60例神经根型、脊髓型或混合型颈椎病患者,按照手术方式分为Mobi-C间盘组和ROI-C融合组。所有患者均完成半年以上有效随访,平均随访时间为(12.1±5.0)个月,分别于术前、术后1周及末次随访时行目测类比评分、颈椎JOA评分以及拍摄X射线片,测量颈椎矢状位参数:C_(2-7)Cobb角、C_(0-2)Cobb角、C_(2-7)矢状面轴向距离、颈椎斜率、T_(1)倾斜角、C_(7)倾斜角、胸廓入口角、脊柱功能单位角,分析两组患者的组内和组间差异,并行Pearson相关性分析。结果与结论:①术后1周及末次随访时,两组患者目测类比评分均较术前明显降低(P<0.05)、颈椎JOA评分显著增高(P<0.05)。②与术前相比,术后1年的随访间盘组C_(2-7)Cobb、C_(2-7)矢状面轴向距离和T_(1)倾斜角差异无显著意义(P>0.05),C_(0-2)Cobb角、高T_(1)倾斜角减小(P<0.05),脊柱功能单位角增大(P<0.05);融合组C_(2-7)Cobb、C_(2-7)矢状面轴向距离和T_(1)倾斜角差异无显著意义(P>0.05),脊柱功能单位角和C_(7)倾斜角增高(P<0.05);间盘组比融合组脊柱功能单位角增高(P<0.05)。③患者术后矢状位参数,融合组C_(2-7)Cobb与C_(7)倾斜角呈显著正相关;颈椎斜率与胸廓入口角呈显著正相关;T_(1)倾斜角与C_(7)倾斜角呈显著正相关;C_(7)倾斜角与C_(0-2)Cobb角呈显著负相关。置换组C_(2-7)Cobb与C_(7)倾斜角、脊柱功能单位角和T_(1)倾斜角呈显著正相关,与C_(0-2)Cobb角呈显著负相关;颈椎斜率与胸廓入口角呈显著正相关,与C_(2-7)矢状面轴向距离、T_(1)倾斜角和脊柱功能单位角呈显著负相关;C_(2-7)矢状面轴向距离与C_(7)倾斜角、脊柱功能单位角、T_(1)倾斜角呈显著正相关;T_(1)S与C_(7)倾斜角、脊柱功能单位角呈显著正相关,C_(7)倾斜角与脊柱功能单位角呈显著正相关。④间盘组中,高T_(1)倾斜角型患者术后胸廓入口角、T_(1)倾斜角和C_(0-2)Cobb角较术前明显降低(P<0.05),而脊柱功能单位角较术前明显增高(P<0.05);而融合组未发现显著变化。⑤结论:Mobi-C间盘和ROI-C融合器治疗单节段颈椎病疗效显著,与ROI-C融合器相比,Mobi-C间盘主要通过重建颈椎局部前凸角和上颈椎前凸角来恢复生理曲度,并且在高T_(1)倾斜角患者群体中仍然保持这种能力。

Cervical Spine Cord Injury Associated with Klippel-Feil Syndrome: A Case Report

Background: Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. Aim: The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. Case presentation: A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. Conclusion: Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.

Clinical and radiological outcomes of dynamic cervical implant arthroplasty:A 5-year follow-up

BACKGROUND Dynamic cervical implant(DCI)stabilization has been reported to have satisfactory clinical and radiological results with short-and mid-term follow-up in the treatment of cervical degenerative disc disease.However,few reports about the clinical and radiological outcome with more than 5-year follow-up exist.AIM To investigate the long-term clinical and radiological results of DCI arthroplasty.METHODS A total of 40 patients who received DCI arthroplasty were consecutively reviewed from May 2010 to August 2015.Visual analogue scale(VAS),neck disability index(NDI)score,Japanese Orthopaedic Association(JOA)score,and SF-36 items were used to assess neural function rehabilitation.Static and dynamic radiographs and 3-dimentional computed tomography were used to evaluate the radiological outcomes.RESULTS The scores of neck/arm VAS,NDI,JOA,and 8-dimensions of SF-36 were significantly improved at the 1-mo follow-up(P<0.05)and maintained until the last follow-up(P<0.05).The range of motion(ROM)of C2-C7,functional spinal unit(FSU),upper/lower adjacent level,C2-C7 lateral bending,and FSU lateral bending decreased at the 1-mo follow-up(P<0.05),whereas they increased to the preoperative level at the later follow-up intervals(P>0.05),except the ROM of FSU lateral bending(P<0.05).The C2-C7 alignment and FSU angle kept more lordotic at the last follow-up(P<0.05).The intervertebral height increased significantly at the 1-mo follow-up(P<0.05)and decreased at later follow-ups(P>0.05).At the last follow-up,12(26.1%)segments developed heterotopic ossification.CONCLUSION DCI arthroplasty is a safe and effective non-fusion technique to treat cervical degenerative disc disease in long-term follow-up.

Cervical Diseases Prediction Using LHVR Techniques

The stabilizing mechanisms of cervical spine spondylosis are involved in the degenerating segmentation vertebra,which often causes pain.Health of the individual is affected,both physically and mentally.Due to depression,nervous-ness,and psychological damages occur thereby losing their human activity func-tions.The nucleus pulposus of spinal disc herniation is prolapsed through a deficiency of annulusfibrosus.A jelly-like core part of the disc contains proteins that cause the tissues to become swollen when it touches the nucleus pulposus.The proposed Gradient Linear Classification(GLC)algorithm is used for the effi-cient automatic classification of disc degeneration herniation of Inter vertebral/vertebra in a cervical disc.Distance between the disc degeneration is classified through gradient operator and is estimated using the rotation of angles between the correlations.Specialists of the orthopedic spine are searching for high-preci-sion algorithms,which are achieved using proposed Linear Hybrid Vertebra Regression(LHVR)diagnostic techniques to identify the degree of cervical disc degeneration using an accurate location.Our experimental results have been used to determine a high range of classification in predicting the spinal cord which saves handling time and accomplishes high accuracy in detection.

益气活血通络方对脊髓型颈椎病模型大鼠miR-126a-5p及VEGF信号通路的影响

目的探讨益气活血通络方对脊髓型颈椎病模型大鼠微小RNA-126a-5p(miR-126a-5p)及血管内皮生长因子(VEGF)信号通路的影响。方法30只健康雄性SD大鼠按照随机数字表法均分为假手术组、模型组和中药组。模型组、中药组均制备脊髓型颈椎病模型。中药组给予益气活血通络方灌胃,假手术组、模型组给予生理盐水灌胃,均为12周。各组干预结束后进行大鼠行为学测试,测定机械性刺激阈值和热刺激回缩时间。处死大鼠,HE染色观察各组椎间盘软骨终板结构的差异。TUNEL染色观察大鼠椎间盘纤维环细胞变化。实时荧光定量聚合酶链式反应检测大鼠椎间盘纤维环组织miR-126a-5p和VEGF mRNA。采用Western blot法检测大鼠椎间盘纤维环组织VEGF蛋白表达。结果与假手术组比较,模型组大鼠椎间盘血管芽数目减少,大鼠椎间盘纤维环细胞破坏明显、大量凋亡且细胞密度降低;模型组和中药组机械性刺激阈值降低,热刺激回缩时间缩短,miR-126a-5p水平降低,VEGF mRNA和蛋白表达水平升高(P<0.05)。与模型组比较,中药组大鼠椎间盘血管芽数目增加,大鼠椎间盘纤维环细胞破坏减轻,大鼠椎间盘纤维环细胞凋亡减少且细胞密度增加,机械性刺激阈值升高,热刺激回缩时间延长,miR-126a-5p水平增加,VEGF mRNA和蛋白表达水平降低(P<0.05)。结论益气活血通络方治疗脊髓型颈椎病的机制可能与上调miR-126a-5p、下调VEGF表达有关。