The London Spine Unit : most established spine facility in UKPublished articleObjective: To investigate the influence of the preoperative factors on the segmental range of motion (ROM) during long-term follow-up after artificial cervical disc replacement (ACDR), so as to further improve the selection of surgical indications for ACDR. Methods: Retrospective analysis was performed on 71 patients with cervical degenerative diseases who underwent single-segment Bryan ACDR in Beijing Jishuitan Hosptial from December 2003 to December 2008, and a 10-year clinical follow-up was…Cervical Disc Replacement Expert. Best Spinal Surgeon UKThe London Spine Unit is a specialist clinic for Cervical Disc Replacement as Day Surgery.
To investigate the influence of the preoperative factors on the segmental range of motion (ROM) during long-term follow-up after artificial cervical disc replacement
(ACDR), so as to further improve the selection of surgical indications for ACDR. Methods:
Retrospective analysis was performed on 71 patients with cervical degenerative diseases who underwent single-segment Bryan ACDR in Beijing Jishuitan Hosptial from December 2003 to December 2008, and a 10-year clinical follow-up was conducted. Among the patients, 44 were males and 27 were females, with a mean age of (45±8) years at operation. The mean follow-up time was (129±14) months. Preoperative and follow-up imaging evaluation including measurement of the segmental range of motion (ROM) by cervical X-ray, and preoperative height of intervertebral space was measured by cervical lateral X-ray. According to CT and coronal reconstruction, the grade of paravertebral ossification (PO) was assessed. Clinical symptoms assessment including the Japanese Orthopaedic Association scoring (JOA), the Neck Disability Index (NDI) evaluation was performed preoperatively. Multivariate logistic regression analysis was used to analyze the influencing factors of the range of motion of the surgical segment during follow-up. The best cut-off value was calculated by receiver operating characteristic (ROC) curve. Results:
The preoperative and follow-up ROM at the operated segment was 9.7°±4.5° and 8.7°±5.4°, respectively (P
>0.05). Univariate analysis revealed that the postoperative segmental ROM was not significantly correlated with the factors including the surgical level, gender, age, and preoperative clinical diagnosis (1: Radiculopathy; 2: Myelopathy; 3: Mixed type), preoperative segmental ROM, preoperative JOA score and preoperative NDI score (all P
>0.05), and was significantly correlated with imaging diagnosis (1: cervical disc herniation; 2: degenerative cervical stenosis), preoperative PO grade (both P
<0.05). The multi-factor analysis showed that preoperative segmental ROM (OR
<0.05) and PO grade (OR
: 0.085-0.424, P
<0.05) had significance in the overall test, but imaging diagnosis had no significance in the overall test (P
>0.05). The optimal cutoff value of preoperative segmental ROM and PO grade was 9.185° and grade 2.5 assessed by ROC curve, and the area under the ROC curve was 0.86 and 0.72, respectively. Conclusions:
ACDR surgery can achieve satisfactory long-term effects for patients with nerve root type, spinal cord type and mixed type cervical degenerative diseases, and effectively retain the overall ROM of the cervical spine and the ROM of replacement segments. Patients with good preoperative segmental ROM and lower PO levels have a greater chance of obtaining good segmental ROM in the long-term postoperatively.
Through the long-term follow-up of patients after cervical artificial disc replacement
(ACDR), to retrospectively explore the preoperative Factors have an influence on the segmental mobility of the long-term follow-up after ACDR operation, and further improve the selection of indications for ACDR surgery. Method:
Retrospective analysis of the Department of Spine Surgery, Beijing Jishuitan Hospital 2003years To 2008 year 12 month 71 example Clinical data of patients with cervical degenerative disease who underwent single-segment Bryan ACDR, all patients were accepted 10 annual clinical follow-up. Among them male 44 cases, female 27 cases; postoperative follow-up time (129±14) months; age at the time of surgery (14 ± 8) years . Preoperative and follow-up imaging evaluations include measuring the flexion and extension range of cervical spine replacement segment by cervical dynamic X-rays, measuring the height of the preoperative intervertebral space through cervical lateral neutral X-rays, and evaluating the paravertebral bones through CT and imaging reconstruction The level of clinical symptoms (PO), and the evaluation of clinical symptoms include the Japanese Orthopaedic Association Score (JOA) and the Cervical Dysfunction Index (NDI). Binary logistic regression analysis was used to carry out a multivariate analysis of the factors influencing surgical segment mobility during follow-up, and the receiver operating characteristic (ROC) curve was used to calculate the best cut-off value of the index with statistical significance for the difference. Results:
The range of motion of the surgical segment before and at the last follow-up was 9.7°±4.5° and 8.7°±, respectively 5.4°, there is no statistically significant difference between before and after (P
>0.05). Univariate analysis found that the long-term follow-up of patients after ACDR had no correlation with gender, age, surgical segment, preoperative symptomatic diagnosis, preoperative surgical segment mobility, preoperative JOA and NDI scores (both P
>0.05), and the patient’s imaging diagnosis (1: cervical disc herniation; 2: degenerative cervical spinal stenosis) and surgery There is a correlation between the previous PO ratings (both P
<0.05). Multivariate analysis found that preoperative segmental mobility (OR
: 1.012~1.489, P
<0.05) and PO classification are statistically significant in the overall test (OR
: 0.085~0 .424, P
<0.05), there is no statistically significant difference in imaging diagnosis (P
>0.05). The optimal cut-off value of ROC curve calculation for preoperative segmental mobility and PO grading is 9.185° And 2.5, the area under the curve is 0.86 and 0.72.
ACDR surgery can achieve satisfactory long-term effects for cervical degenerative diseases, effectively retaining the overall range of motion and replacement of the cervical spine Segment activity. Patients with good preoperative segmental mobility and low paravertebral ossification levels have a greater chance of obtaining good segmental mobility in the long-term postoperatively. .