Objective To evaluate the long-term effect of excessive length of bone graft via anterior cervical approach and over distraction of intervertebral space on cervical curvature and postoperative neck axial symptom (AS). Methods FromJune 2001 to June 2004, 30 patients with nerve root cervical spondylosis at the C5,6 level underwent anterior cervicaldecompression, autogenous il iac bone graft and internal fixation with titanium plate. There were 14 males and 16 females aged 32-73 years old (average 54.7 years old), and the course of disease was 1-31 months (average 7 months). No instabil ity of cervical vertebrae was noted on the cervical dynamic position x-ray films. Intervertebral height was measured immediately after operation, and accordingly the patients were divided into two groups: the over distraction group (n=11), in which the length of bone graft was excessive, the intervertebral space was over distracted, and the intervertebral height was increased by more than 3 mm compared with the preoperative value; the proper distraction group (n=19), in which the length of bone graft was proper, no over distraction of the intervertebral space occured, and the intervertebral height was increased by less than 3 mm compared with the preoperative value. Regular X-ray exams were performed 1 week and 3, 24, and 48 months after operation to analyze bone fusion condition of the grafted bone, changes of the intervertebral height of the fused segments, and variation of physiological curvature of the cervical vertebra. The postoperative neck AS was evaluated according to the the neck AS evaluation criteria set by ZENG Yan and co-workers. Results All patients were followed up for 48-66 months (average 54.5 months). Cl inical symptoms were el iminated in all cases. No compl ications occurred in the proper distraction group; 1 patient of the over distraction group had ostoperative nerve root paralysis at C5 level, and recovered 3 months after proactive treatment. Bone fusion was achieved in all patients 3-6 months after operation, except for 1 case in the proper distraction group suffering from non-fusion 12 months after operation. There was no occurrence of loosening or breakage of steel plate and screw, and no displacement of the grafted bone. At 48 months after operation, the intervertebral height of the proper distraction group and the over distraction group was increased by (1.9 ± 1.8) mm and (3.5 ± 2.7) mm, respectively, when compared with the preoperativevalue (P gt; 0.05). The physiological curvature of the operated cervical segment was well maintained. The curvature of the proper distraction group and the over distraction group at the final follow-up visit was increased by (2.17 ± 1.83)° and (3.32 ± 2.71)°, respectively, when compared with the preoperative value (P gt; 0.05). The physiological curvature of the whole cervical vertebra at the final follow-up visit was increased by (4.57 ± 3.71)° in the proper distraction group and decreased by (2.43 ± 2.13)° in the over distraction group, when compared with the preoperative value (P lt; 0.05). The incidence rate of postoperative neck S at 48 months after operation was 15.79% in the proper distraction group (11 cases excellent, 5 cases good, 3 cases fair) and 54.55% in the over distraction group (3 cases excellent, 2 cases good, 5 cases fair, 1 case poor), showing a significant difference between two groups (P lt; 0.05). Conclusion Excessive length of bone graft via anterior cervical approach and over distraction of intervertebral space are bad for maintaining the physiological curvature of the whole cervical vertebra, and increase the incidence of postoperative neck AS. Selection of bone graft at the proper height is essential in anterior cervical operation.
ObjectivesTo investigate the status quo of follow-up services for patients with cervical spondylosis, to explore its influencing factors, and to provide reference for the follow-up management model after postoperative discharge of patients with cervical spondylosis.MethodsA total of 220 patients with cervical spondylosis were selected by using convenient sampling from October 2018 to May 2019, and the general information questionnaire and the follow-up service needs questionnaire were used for the investigation.ResultsThe score of follow-up service content requirement for patients with cervical spondylosis was 54.87±7.56, and the rehabilitation training instruction was the highest. Multiple linear regression analysis showed that the follow-up service content score was influenced by education level [non-standardized partial regression coefficient (b)=3.186, 95% confidence interval (CI) (2.490, 3.882), P<0.001], length of hospital stay [b=5.140, 95%CI (3.914, 6.365), P<0.001], Neck Disability Index [b=1.326, 95%CI (0.189, 2.463), P=0.022], and age [≥75 years as the reference, 45-59 years: b=3.766, 95%CI (0.671, 6.860), P=0.017; 60-74 years: b=4.081, 95%CI(0.849, 7.314), P=0.014]. The method of obtaining follow-up services was mainly based on outpatient follow-up (85.5%), telephone follow-up (50.5%), and established a follow-up service center (40.5%) for discharged patients. The executives were multidisciplinary teams (60.5%) and hospital-community integration teams (48.2%). There were 19.1% of discharged patients who were willing to pay for relevant follow-up services.ConclusionsPatients with postoperative cervical spondylosis have strong demand for post-discharge follow-up services, which are affected by many factors. Medical staff should pay attention to this and develop a personalized follow-up service plan according to patient characteristics to meet different discharged patients and improve the quality of medical services.
ObjectiveTo study the efficacy of anterior cervical Vectra-t dynamic plate and titanium mesh for cervical spondylosis.
MethodsA retrospectively analysis involving 20 cases (44 sections) from June 2010 to October 2012 was performed in the department of orthopaedic in the West China Hospital of Sichuan University. All patients received the operation of anterior cervical vertebral resection decompression, titanium mesh and bone graft, and Vectra-T plate. The data of the JOA scores, cervical curvature, the conditions of vertebral body fusion after bone graft and the situation of titanium mesh subsidence were all collected. Statistical analysis were performed using SPSS 19.0 software.
Resultsa) All the 20 cases received a 12-to 30-month follow-up. The results of statistical analysis showed that:the JOA scores were as follows:7.68±1.66 for preoperative, 10.91±1.97 for after surgery and 12.74±1.27 for the endpoint of follow-up, and significant differences were found between these scores (P < 0.05). b) There was no loose of screw or plate. The local cervical angle and regional cervical angle were improved after surgery. In the 44 segments of fusion, 43 segments fused within 6 months, one of the segment delayed to fuse 12 months after surgery. c) The subsidence of titanium mesh were 2.7±2.7 mm on average in 3 months after surgery, 3.6±1.0 mm on average in 6 months after surgery, 3.9±1.2 mm on average in 12 months after surgery and 4.0±1.2 mm on average in last follow-up. Titanium mesh subsidence mainly concentrated in the postoperative period of 6 months. After six months of titanium mesh subsidence was no longer apparent.
ConclusionThe application of Vectra-T dynamic plate can effectively improve the curvature of the cerical sagittal position, prevent protrusion deformity, reduce the related complications after bone graft, effectively avoid the stress shelter in the static plate, andspromote the fusion between the cervical vertebral bodies. However, the long-term curative effects are still needed to be assessed by large sample randomized controlled trials with long-term follow-up.
ObjectiveTo analyze the effectiveness of a new type of decellularized allogeneic bone in the application of anterior cervical discectomy and fusion (ACDF).
MethodsA retrospective analysis was made on the clinical data of 73 patients with single segmental cervical spondylosis treated with ACDF between January 2009 and December 2013. Of 73 cases, autologous iliac bone was used in 22 cases (group A), new decellularized allogeneic bone transplantation (Bio-Gene) in 22 cases (group B), and normal allogeneic bone (Xin Kang Chen) in 24 cases (group C). There was no significant difference in gender, age, type of cervical spondylosis, course of disease, and involved segment among 3 groups (P>0.05). The operation time, intraoperative blood loss, and complications were compared between groups; X-ray films and CT images were taken to observe the bone fusion, and Japanese Orthopaedic Association (JOA) score was used to assess the clinical efficacy.
ResultsThe operation time and intraoperative blood loss of group A were significantly more than those of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Pain and numbness at donor site occurred in 12 cases, and poor healing in 1 case of group A; red swelling and exudate were observed in 1 case of group B and in 6 cases of group C; and there was significant difference in complications among 3 groups (χ2=18.82, P=0.00). All patients were followed up 6-54 months (mean, 30 months). The graft fusion rate was 100% in groups A and B, and was 95.8% in group C, showing no significant difference (χ2=2.04, P=0.36). The JOA score at 6 months after operation were significantly improved when compared with preoperative score in 3 groups (P<0.05), but no significant difference was found among the 3 groups at preoperation and 6 months after operation (P>0.05). The excellent and good rates of groups A, B, and C were 90.9%, 88.9%, and 87.5% respectively, showing no significant difference (χ2=0.14, P=0.93).
ConclusionNew type of decellularized allogeneic bone in ACDF has the advantages of shorter operation time, less blood loss, and better early effectiveness. But whether there is a chronic rejection or delayed rejection needs further studies.
Objective
To evaluate the early outcome of anterior cervical discectomy and fusion (ACDF) using a Zero-profile implant system (Zero-P) for interbody fusion in the treatment of cervical spondylosis.
Methods
Between March 2010 and June 2011, 25 patients with cervical spondylosis underwent ACDF with Zero-P. There were 13 males and 12 females with an average age of 44.2 years (range, 26-67 years), including 14 cases of nerve root cervical spondylosis, 6 cases of spinal cervical spondylosis, and 5 cases of mixed cervical spondylosis. The disease duration was 3-120 months (median, 25 months). Single segment was involved in 20 cases, 2 segments in 4 cases, and 3 segments in 1 case. A total of 31 Zero-P were implanted (3 at C3, 4, 8 at C4, 5, 12 at C5, 6, and 8 at C6, 7). Primary cervical operation was performed in 23 cases and re-operation in 2 cases. Before and after operation, the height of intervertebral space and the cervical Cobb angle were measured; clinical outcome was evaluated using visual analogue scale (VAS) score for pain in the neck and upper limb, and Japanese Orthopaedic Association (JOA) score for myelopathy; and intervertebral fusion and the incidence of dysphagia were also observed.
Results
All incisions healed by first intention. All the patients were followed up 12-16 months (mean, 13.9 months). Interbody bone fusion was obtained, and the fusion time was 2.7-6.0 months (mean, 3.8 months). Three patients had dysphagia after operation; symptom disappeared at 1 week and 3 months after operation in 2 cases and 1 case, respectively. No fixation loosening, subsidence, or breakage occurred. The height of intervertebral space was significantly improved (P lt; 0.05) from (4.5 ± 0.5) mm at preoperation to (6.0 ± 0.7) mm at 1 week and (5.7 ± 0.6) mm at 12 months after operation; the cervical Cobb angle was significantly improved (P lt; 0.05) from (11.9 ± 6.1)° at preoperation to (21.2 ± 4.1)° at 1 week and (20.2 ± 3.7)° at 12 months after operation; and there was no significant difference between at 1 week and 12 months after operation (P gt; 0.05). The VAS score was significantly reduced (P lt; 0.05) from 7.1 ± 0.8 at preoperation to 1.9 ± 0.8 at 3 months and 1.0 ± 0.5 at 12 months after operation; the JOA score was significantly increased (P lt; 0.05) from 9.6 ± 1.3 at preoperation to 13.5 ± 1.0 at 3 months and 14.9 ± 1.0 at 12 months after operation; and there was significant difference between at 3 months and at 12 months after operation (P lt; 0.05).
Conclusion
The early outcome of ACDF using a Zero-P in the treatment of cervical spondylosis is satisfactory and reliable, and it can restore and maintain the cervical alignment and disc height, and disc has low incidence of postoperative dysphagia.
Objective To study the effectiveness of artificial disc replacement for cervical diseases and the adjacent segment degeneration. Methods Between January 2008 and October 2010, 39 cases of cervical spondylosis underwent cervical disc replacement. Of them, there were 20 males and 19 females with an average age of 45.7 years (range, 32-60 years)and an average disease duration of 30 months (range, 1 month to 10 years), including 26 cases of cervical myelopathy, 11 cases of nerve root cervical spondylosis, and 2 cases of mixed cervical spondylosis. Single level disc lesion was observed in 27 cases while bi-level lesion in 12 cases. Prestige disc prosthesis was used in 9 patients, Prodisc-C prosthesis in 4 patients, and Discover disc prosthesis in 26 patients. The neurological functional recovery was assessed after operation by Japanese Orthopaedic Association (JOA) score. The range of motion of replaced segment and adjacent segments was measured (Cobb angle), and Kellgren’s X-ray assessment was used to evaluate the degree of adjacent segment degeneration. Results The operation was successfully performed in all cases, with primary heal ing of all the incisions. All patients were followed up from 12 to 36 months with an average of 23.1 months. JOA score was significantly improved at last follow-up when compared with preoperative score (P lt; 0.05), and no significant difference was observed in the Cobb angle of replaced segment and adjacent segments between pre- and postoperation (P gt; 0.05). According to the Kellgren’s X-ray assessment, degeneration of the adjacent segments occurred in 5 cases at last follow-up, including 3 cases of degeneration from grade 0 to grade 1 or 2, 1 from grade 1 to grade 2, and 1 from grade 2 to grade 3, with a degeneration rate of 12.8%, but no significant difference was found in degeneration degree when compared with preoperative value (χ2=1.793，P=0.406). No degeneration of adjacent segments occurred in 32 patients at 15 months after operation. Conclusion Artificial disc replacement has a good effectiveness in treating cervical spondylosis, which can maintain the range of motion of the replaced segment and adjacent segments, and may have a protective effect on adjacent segment discs.
Objective To explore the neck axial symptom (AS) after Bryan cervical disc arthroplasty traditional anterior cervical discectomy and fusion, and to make contrastive analysis. Methods From October 2004 to April 2006, 22 patients, 13 males and 9 females, aged 33-54 years old (43.3 on average), underwent Bryan cervical disc placement (groupA). Among them, there were 16 cases of cervical spondylotic myelopathy and 6 of nerve root cervical syndrome, with 20of single segment replacement and 2 of two segments replacement. The courses of disease were 1-21 months (6 months on average). Meanwhile, 30 patients, 17 males and 13 females, aged 35-64 years old (50.3 on average) underwent traditional anterior cervical discectomy and fusion (group B). Among them, there were 19 cases of cervical spondylotic myelopathy and 11 of nerve root cervical syndrome, with 26 of single segments replacement and 4 of two segments replacement. The course of disease was 1-23 months (7 months on average). In both groups, the neurologic recovery rate, the change of cervical curvature of the operated segments and total range of motion (ROM), and incidence of neck axial symptoms were recorded and compared. Results All the patients were followed up for 24-42 months (30.6 months on average). There was no graveness compl ication happening during and after operation in both groups. There were no compl ications of prosthesis bit shifting and amotio in group A, and group B exhibited a bony fusion on X-ray films 6 months after operation, without plate and bolt loose or broken. The patients’ cl inical symptoms of radiculopathy were obviously rel ieved and the curative effect was satisfactory in two groups of nerve root cervical syndrome. In both groups of cervical spondylotic myelopathy, the patients’ JOA scores at the postoperative follow-up increased obviously than preoperative (Plt; 0.01), and there was no significant difference between the two groups before the operation and at the end of the follow-up (P gt; 0.05). The rate of sagittal al ignment of the operated segment with kyphosis increased obviously in group B, higher than in group A (P lt; 0.05).The total ROM of group B was obviously lower than preoperative (Plt; 0.01), and the pre- and postoperative difference of group A was not statistically significant (P gt; 0.05). The rate of postoperative neck AS was 18.18% in group A and 46.67% in group B, and the difference was statistically significant(Plt; 0.05). Conclusion Compared with traditional anterior cervical discectomy and fusion, the use of Byran disc arthroplasty for cervical syndrome is associated with good outcomes. At the same time, it can maintain the cervical motion and curvature of operated segments, avoid the decrease of total ROM and lower the incidence of the postoperative neck AS.
Objective To investigate the cl inical effect of cervical artificial disc replacement (CADR) on twosegment cervical spondylosis and to research its influences on the range of motion (ROM) of the diseased segments and theadjacent superior and inferior segments. Methods From September 2004 to February 2007, 7 cases with cervical spondylosis at C4,5 and C5,6 were treated with CADR using Bryan artificial disc prosthesis, including 4 males and 3 females aged 30-45 years old (average 38.5 years old). All the patients had cervicodynia in various degrees, pain and numbness of l imbs and decreased muscle strength, including 3 cases of cervical spondylotic radiculopathy, 3 of cervical spondylotic myelopathy and 1 of mixed cervical spondylosis. The course of disease was 12-54 months (average 27 months). Preoperatively, X-ray films revealed the intervertebral space of C4, 5 and C5,6 was narrowed and the cervical curve became straight, CT or MRI showed the intervertebral disk hernia of C4, 5 and C5,6, and the hyperostosis of vertebral margin compressed nerve root or spinal cord. All the patients had no response to the preopratively conservative treatment. JOA score and ROM of the diseased segments and the adjacent superior and inferior segments were compared before and after operation. Results All the patients survived the perioperative period, without hoarse voice, muscle spasm, dysphagia and cervicodynia. X-ray films showed the implanted prosthesis was well located, the height of intervertebral space was normal, and no prosthesis loosening, prosthesis migration and infection occurred 12 months after operation. All the 7 cases were followed up for 12-41 months (average 26.7 months). Cervicodynia and l imbs’pain and numbness disappeared, and muscle strength was improved obviously. The JOA score before and during the followup period was (8.35 ± 1.27) and (14.65 ± 1.61) points, respectively, indicating there was a significant difference (P lt; 0.05). For the ROM of C4,5 and C5,6, it was (8.38 ± 0.48)° and (9.16 ± 0.54)° before operation, respectively, and it increased to (11.15 ± 0.65)° and (12.75 ± 0.73)° after operation, respectively, showing there was a significant difference (P lt; 0.05). The ROM at C3,4 and C6,7 before operation was (9.71 ± 0.76)° and (12.39 ± 0.58)°, espectively, while it was improved to (10.26 ± 0.47)° and (13.67 ± 0.71)° after operation, respectively, indicating there were no significant differences between before and after operation (P gt; 0.05). Conclusion The appl ication of Bryan Disc CADR for two-segment cervical spondylosis has satisfying therapeutic effects, can improve the ROM of diseased segments obviously, and has minor influences on the ROM of adjacent superior and inferior segment.
The incidence of perioperative sleep disorders in patients with cervical spondylosis is high, which affects the physiological and psychological rehabilitation effect of patients after surgery. The expert consensus (preliminary draft) was prepared by summarizing expert experience and recommendations. After expert review and revision, the consensus was formed. The consensus was developed based on existing evidence-based medical evidence and expert clinical experience, which is scientific and practical and can provide a basis for clinical medical personnel to prevent and treat perioperative sleep disorders in patients with cervical spondylosis.
ObjectiveTo explore the surgical indication and summarize the experiences of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylosis.
MethodsSeventy-five cases of cervical spondylosis were treated with ACDF from January 2010 to October 2013, including 34 cases of cervical spondylotic radiculopathy and 41 cases of cervical spondylotic myelopathy. The pre/post-operative Japanese Orthopedic Association (JOA) score and imaging data were observed.
ResultsThirty-six patients were followed up for 6 to 25 months, with an average of 16 months. The mean JOA score before surgery was 10.67±2.66, and 3 months later, the score was 13.47±2.06. Six months later the score was 14.11±1.56, and after 12 months the score was 14.97±1.78. No spinal cord injury or esophagus, trachea injury occurred, and there was no superior laryngeal nerve and recurrent laryngeal nerve injury during the operation. Eight cases of postoperative dysphagia obviously decreased within 3-5 days, 6 cases decreased within 5-7 days, and 10 cases decreased within 3 weeks. And all 36 patients recovered within one month. There was no titanium mesh subsidence, displacement or titanium plate failure after operation.
ConclusionACDF is suitable for the decompression of spinal cord or nerve root which is compressed by the degenerated intervertebral disc, especially without rigid kyphosis, ossification of the posterior longitudinal ligament extending across multiple segments, and the compression located at the level of intervertebral disc. The appropriate approach can achieve a stable efficacy, less interference on the stability of the spine, and the incision heals fast. It is a kind of classic anterior cervical operation for it can reduce the complication effectively.
