CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SIWenteng ¹ , ZHANGHuaguo ² , WANGAiguo ¹ , SUNYibao ¹ , BAIYu ¹

1. Department of Orthopedics, Zhengzhou Orthopedics Hospital, Zhengzhou Henan, 450032, P. R. China;
2. Department of Nursing, Henan Medical College for Staff and Workers;

Corresponding?author：

SIWenteng, Email: swteng516@163.com

Keywords：

Cervical intervertebral disc protrusion; Dynamic cervical implant; Cage; Bone graft fusion

DOI：

10.7507/1002-1892.20140014

Video：

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Objective To discuss the safety and effectiveness of combined dynamic cervical implant (DCI) and Cage fusion in the treatment of two-level cervical disc protrusion. Methods Between September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years (range, 37-64 years) and with a mean disease duration of 5.1 years (range, 2-8 years), including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C_3,4 and C_4,5 (1 case), C_3,4 and C_5,6(5 cases), C_4,5 and C_5,6 (3 cases), C_4,5 and C_6,7 (5 cases), and C_5,6 and C_6,7 (2 cases). The neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analogue scale (VAS) were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up. Results Primary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average (range, 6-36 months). The cervical X-ray results indicated that the activities of involved segments was (7.8±3.1)°, showing no significant difference (t=0.655, P=0.132) when compared with preoperative value [(7.3±2.6)°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months (range, 3-8 months). NDI, JOA, and VAS scores at last follow-up (18.3±5.1, 15.7±1.5, and 3.4±1.8 respectively) were significantly improved (t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038) when compared with preoperative scores (49.6±11.3, 12.8±2.0, and 6.7±1.2 respectively). Conclusion A combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.

Citation： SIWenteng, ZHANGHuaguo, WANGAiguo, SUNYibao, BAIYu. CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 60-63. doi: 10.7507/1002-1892.20140014 Copy

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2.	Lee MJ,Dumonski M,Phillips FM,et al.Disc replacement adjacent to cervical fusion:a biomechanical comparison of hybrid construct versus two-level fusion.Spine (Phila Pa 1976),2011,36(23):1932-1939.
3.	李冰,王沛,李暉,等.Bryan頸椎間盤置換術與頸前路減壓椎間融合術術后療效的系統評價.中國脊柱脊髓雜志,2009,19(7):497-501.
4.	楊大龍,申勇,曹俊明,等.頸人工椎間盤置換近期并發癥分析.中國脊柱脊髓雜志,2008,18(4):249-252.
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14.	李勤,田偉,劉波,等.多節段頸椎人工椎間盤置換術的臨床研究.中華醫學雜志,2007,87(17):1173-1176.
15.	任先軍,初同偉,蔣濤.頸椎間盤置換與相鄰節段融合的治療選擇.中華創傷雜志,2011,27(5):418-422.
16.	毛寧方,趙穎川,倪海健,等.頸前路非融合與融合技術聯合應用治療頸椎病.中國脊柱脊髓雜志,2012,22(6):531-535.
17.	Zhang X,Zhang X,Chen C,et al.Randomized,controlled,multicenter,clinical trial comparing BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion in China.Spine (Phila Pa 1976),2012,37(6):433-438.
18.	陳輝,馬迅,陳晨.Hybrid手術治療頸椎病的研究進展.中華骨科雜志,2013,33(8):868-872.
19.	馬迅,梅軍,馮皓宇,等.Hybrid手術治療脊髓型頸椎病的臨床療效分析.中華骨科雜志,2013,33(8):792-796.
20.	劉海鷹,許曉諾,王波,等.雙節段Hybrid手術治療頸椎病的臨床療效觀察.中華外科雜志,2012,50(3):238-242.

1. Zechmeister I,Winkler R,Mad P.Artificial total disc replacement versus fusion for the cervical spine:a systematic review.Eur Spine J,2011,20(2):177-184.
2. Lee MJ,Dumonski M,Phillips FM,et al.Disc replacement adjacent to cervical fusion:a biomechanical comparison of hybrid construct versus two-level fusion.Spine (Phila Pa 1976),2011,36(23):1932-1939.
3. 李冰,王沛,李暉,等.Bryan頸椎間盤置換術與頸前路減壓椎間融合術術后療效的系統評價.中國脊柱脊髓雜志,2009,19(7):497-501.
4. 楊大龍,申勇,曹俊明,等.頸人工椎間盤置換近期并發癥分析.中國脊柱脊髓雜志,2008,18(4):249-252.
5. Pickett GE,Mrrsis DK,Sekhon LH,et al.Effects of a cervical disc prosthesis on segmental and cervical spine alignment.Neurosurg Focus,2004,17(3):E5.
6. Hsu WK.Advanced techniques in cervical spine surgery.J Bone Joint Surg (Am),2011,93(8):780-788.
7. Goffin J,Geusens E,Vantomme N,et al.Long-term follow-up after interbody fusion of the cervical spine.J Spinal Disord Tech,2004,17(2):79-85.
8. Walraevens J,Demaerel P,Suetens P,et al.Longitudinal prospective long-term radiographic follow-up after treatment of single-level cervical disk disease with the Bryan Cervical Disc.Neurosurgery,2010,67(3):679-687.
9. 郝定均,賀寶榮,許正偉,等.Bryan人工頸椎間盤置換術與椎間融合術治療頸椎病的中期療效比較.中華骨科雜志,2011,31(1):18-23.
10. 高延征,司文騰,余正紅,等.頸椎動態穩定器治療頸椎間盤突出癥的早期臨床療效.中華骨科雜志,2012,32(1):26-31.
11. 丁琛,劉浩,胡韜,等.雙節段Bryan人工頸椎椎間盤置換聯合雙節段融合治療多節段頸椎椎間盤突出癥:5年隨訪結果.脊柱外科雜志,2011,9(5):288-292.
12. 侯振揚,徐耀增,顧葉,等.頸椎動態穩定器置入非融合頸椎的生物力學分析.中國組織工程研究與臨床康復,2011,15(26):4821-4824.
13. 于淼,孫宇,劉忠軍,等.相鄰雙節段頸椎人工椎間盤置換術療效的初步觀察.中國脊柱脊髓雜志,2009,19(1):34-38.
14. 李勤,田偉,劉波,等.多節段頸椎人工椎間盤置換術的臨床研究.中華醫學雜志,2007,87(17):1173-1176.
15. 任先軍,初同偉,蔣濤.頸椎間盤置換與相鄰節段融合的治療選擇.中華創傷雜志,2011,27(5):418-422.
16. 毛寧方,趙穎川,倪海健,等.頸前路非融合與融合技術聯合應用治療頸椎病.中國脊柱脊髓雜志,2012,22(6):531-535.
17. Zhang X,Zhang X,Chen C,et al.Randomized,controlled,multicenter,clinical trial comparing BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion in China.Spine (Phila Pa 1976),2012,37(6):433-438.
18. 陳輝,馬迅,陳晨.Hybrid手術治療頸椎病的研究進展.中華骨科雜志,2013,33(8):868-872.
19. 馬迅,梅軍,馮皓宇,等.Hybrid手術治療脊髓型頸椎病的臨床療效分析.中華骨科雜志,2013,33(8):792-796.
20. 劉海鷹,許曉諾,王波,等.雙節段Hybrid手術治療頸椎病的臨床療效觀察.中華外科雜志,2012,50(3):238-242.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION

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