Four-Level Cervical Disc Arthroplasty.

IF 1.7 Q2 SURGERY
Hsuan-Kan Chang, Chih-Chang Chang, Tsung-Hsi Tu, Yi-Hsuan Kuo, Ching-Lan Wu, Mei-Yin Yeh, Chao-Hung Kuo, Chin-Chu Ko, Li-Yu Fay, Wen-Cheng Huang, Jau-Ching Wu
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引用次数: 0

Abstract

Background: Multilevel anterior cervical discectomy and fusion inevitably yields a higher chance of pseudarthrosis or require more reoperations than single-level procedures. Therefore, multilevel cervical disc arthroplasty (CDA) could be an alternative surgery for cervical spondylosis, as it (particularly 3- and 4-level CDA) could preserve more functional motility than single-level disc diseases. This study aimed to investigate the clinical and radiological outcomes of 4-level CDA, a relatively infrequently indicated surgery.

Methods: The medical records of consecutive patients who underwent 4-level CDA were retrospectively reviewed. These highly selected patients typically had multilevel disc herniations with mild spondylosis. The inclusion criteria were symptomatic cervical spondylotic myelopathy, radiculopathy, or both, that were medically refractory. The clinical outcomes were assessed. The radiographic outcomes, including global and individual segmental range of motion (ROM) at C3-7, and any complications were also analyzed.

Results: Data from a total of 20 patients (mean age: 56 ± 8 years) with an average follow-up of 34 ± 20 months were analyzed. All patients reported improved clinical outcomes compared with that of preoperation, and the ROMs at C3-7 were not only preserved but also trended toward an increase (35 ± 8 vs 37 ± 10 degrees, pre- vs postoperation, P = 0.271) after the 4-level CDA. However, global cervical alignment remained unchanged. There was one permanent C5 radiculopathy, but no other neurological deteriorations or any reoperations occurred.

Conclusion: For these rare but unique indications, 4-level CDA yielded clinical improvement and preserved segmental motility with low rates of complications. Four-level CDA is a safe and effective surgery, maintaining the ROM in patients with primarily disc herniations and mild spondylosis.

Clinical relevance: For patients with mild spondylosis, whose degeneration at the cervical spine is not so severe, CDA is more suitable.

Level of evidence: 4:

四级颈椎椎间盘关节置换术
背景:与单层次手术相比,多层次颈椎椎间盘前路切除和融合术不可避免地会产生更高的假关节几率或需要更多的再次手术。因此,多层次颈椎间盘关节置换术(CDA)可作为颈椎病的替代手术,因为它(尤其是三层和四层CDA)比单层椎间盘疾病能保留更多的功能活动度。本研究旨在调查四级 CDA 的临床和放射学结果,这是一种相对不常用的手术:方法:对连续接受四水平 CDA 患者的病历进行了回顾性审查。这些经过严格筛选的患者通常患有多级椎间盘突出症和轻度脊椎病。纳入标准是有症状的颈椎脊髓病、根性颈椎病或两者兼有,且药物治疗无效。对临床结果进行了评估。此外,还分析了影像学结果,包括C3-7的整体和单个节段活动范围(ROM)以及任何并发症:结果:共分析了 20 名患者(平均年龄:56 ± 8 岁)的数据,平均随访时间为 34 ± 20 个月。与手术前相比,所有患者的临床疗效都有所改善,4级CDA术后,C3-7的ROM不仅得到保留,而且呈上升趋势(35 ± 8 vs 37 ± 10度,手术前 vs 手术后,P = 0.271)。然而,整体颈椎对线保持不变。虽然出现了一次永久性的C5根神经病变,但没有出现其他神经功能恶化或再次手术:结论:对于这些罕见但独特的适应症,四级 CDA 可改善临床症状,保留节段活动度,并发症发生率低。四级CDA是一种安全有效的手术,可维持主要患有椎间盘突出症和轻度脊椎病的患者的活动度:临床意义:对于颈椎退变不严重的轻度脊柱炎患者,CDA 更为适合:4:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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