目的:颈椎间盘置换术(CDA)治疗非连续性颈椎间盘退行性疾病(CDDD)的长期结果仍不确定。此外,目前尚不清楚CDA是否延迟或避免了中间段(IS)的退化,在该领域引起争议。因此,本研究旨在调查CDA治疗非连续性CDDD的中长期临床和影像学结局,并探讨CDA后IS的变性是否比其他非手术治疗的邻近节段快.
方法:我们回顾性分析了2008年1月至2018年7月在我科接受CDA治疗的非连续性CDDD患者。将患者分为CDA组和杂交手术(HS)组,并在术后常规间隔评估临床和影像学结局.使用日本骨科协会(JOA)评估临床结果,颈部残疾指数(NDI),和视觉模拟量表(VAS),而影像学结果包括宫颈前凸(CL),C2-C7运动范围(ROM),分段ROM,和关节成形术水平的椎间盘角度(DA)。还评估了并发症。使用配对t检验或Wilcoxon秩和检验比较术前和术后值。独立学生t检验或Mann-WhitneyU检验分析了CDA和HS组之间的连续数据,而卡方或Fisher精确检验评估分类数据。
结果:64例非连续CDDD患者,CDA组31人,HS组33人,进行了评估。平均随访时间超过70个月。最常见的水平是C4/5和C5/6。两组在JOA方面均有显著改善,NDI,术后VAS值。虽然保持了CL,CDA组的CL始终低于HS组(p<0.05)。C2-C7ROM有显著下降(p<0.05),但在最后的后续行动中,CDA组的C2-C7ROM大于HS组(p<0.05)。在最后一次随访中,44.3%的关节成形术水平发生异位骨化(HO),48.45%的患者发生前骨丢失(ABL)。此外,在IS中观察到相邻节段变性(ASDeg)(22.7%),上相邻段(20.6%)和下相邻段(21.9%)。
结论:CDA或CDA联合融合是治疗非邻接CDDD的可行方法,经过中长期随访,结果令人满意。在70个月的随访后,ASDeg在非手术节段中相似。IS的ROM与术前水平相似,表明CDA不会增加IS变性的风险。
OBJECTIVE: The long-term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid- to long-term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non-surgically treated adjacent segments.
METHODS: We retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2-C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre- and postoperative values were compared using paired t-tests or Wilcoxon rank-sum tests. Independent Student t-tests or Mann-Whitney U tests analyzed continuous data between CDA and HS groups, while chi-square or Fisher exact tests assessed categorical data.
RESULTS: Sixty-four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow-up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2-C7 ROM (p < 0.05), but at the last follow-up, the C2-C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow-up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%).
CONCLUSIONS: CDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid-to-long-term follow-up. ASDeg is similar in non-surgical segments after 70 months of follow-up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration.