Motion analysis of dynamic cervical implant stabilization versus anterior discectomy and fusion: a retrospective analysis of 70 cases
Motion analysis of dynamic cervical implant stabilization versus anterior discectomy and fusion: a retrospective analysis of 70 cases
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DOI：
10.1007/s00586-018-5755-1
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发表时间：
2018-11-01
影响因子：
2.8
通讯作者：
Hou, Tiesheng
中科院分区：
文献类型：
--
作者：
Li, Zhonghai;Wu, Huarong;Hou, Tiesheng
目的回顾性分析单节段动态颈椎植入物（DCI）稳定与颈椎前路椎间盘切除融合术（ACDF）后治疗节段、相邻节段和整个颈椎的运动学。本研究入组了70例症状性单节段颈椎退行性椎间盘疾病（DDD）的连续患者，并分为DCI组（n=35）ACDF组（n=35）。随访5年以上。该研究比较了围手术期参数、临床结局和放射学参数。运动学分析包括治疗节段和相邻节段的活动度（ROM）、整体ROM（C2-C7）以及相邻椎间隙的变化。结果DCI组和ACDF组在SF-36、VAS、NDI和乔亚评分方面的改善无显著差异。DCI稳定导致C2-C7和治疗节段的ROM比ACDF更好。术后24个月和末次随访时，DCI组治疗节段的ROM显著降低，术后24个月后C2-C7 ROM出现不同程度的降低。末次随访时，在4/22例患者中观察到相邻节段退行性变（ASD）的影像学证据（18.2%），5/23例患者ACDF组为21.7%，组间无显著差异结论DCI内固定治疗颈椎DDD不能长时间保持颈椎正常的运动功能，尤其是治疗水平。与ACDF相比，DCI稳定不能降低ASD的风险。
Purpose Retrospective kinematic analysis of treated level, adjacent levels, and overall cervical spine after single-level dynamic cervical implant (DCI) stabilization versus anterior cervical discectomy and fusion (ACDF).Methods Between June 2009 and March 2013, 70 consecutive patients with a symptomatic single-level cervical degenerative disk disease (DDD) were enrolled in this study and divided into DCI (n=35) group and ACDF (n=35) group. All cases were followed up for more than 5years. The study compared perioperative parameters; clinical outcomes; and radiological parameters. Kinematic analysis included range of motion (ROM) of treated level and adjacent level, overall ROM (C2-C7), and changes in adjacent disk spaces.Results There were no significant differences between the DCI group and ACDF group in terms of improvement in the SF-36, VAS, NDI, and JOA scores. DCI stabilization resulted in better ROM of C2-C7 and the treated level than ACDF did. The ROM of treated level decreased significantly at 24months after surgery and last follow-up in the DCI group, and the C2-C7 ROM showed different degrees of reduction after the 24months after surgery. Radiological evidence of adjacent segment degeneration (ASD) at last follow-up was observed in 4/22 patients (18.2%) in the DCI group and 5/23 patients (21.7%) in the ACDF group which was not a significant difference between groups (p>0.05).Conclusions DCI stabilization for the treatment of cervical DDD cannot preserve the normal kinematics of the cervical spine for a long time, especially the treated level. DCI stabilization cannot decrease the risk of ASD compared with ACDF.