颈椎人工椎间盘置换后对相邻节段退变的影响

Effect of cervical disc arthroplasty on adjacent segment degeneration

中文关键词:  颈椎人工椎间盘置换  相邻节段退变  相邻节段疾病

英文关键词:Cervical disc replacement  Adjacent segment degeneration  Adjacent segment disease

中文摘要:

  【摘要】 目的：观察单节段颈椎人工椎间盘置换术后相邻节段退变情况。方法：截止到2010年10月在我院行单节段颈椎人工椎间盘置换术后随访20个月以上且资料完整、既往无颈椎手术史的患者80例，置换节段为C3/4 8例，C4/5 15例，C5/6 49例，C6/7 8例；41例为Bryan Disc置换术，39例为ProDisc-C置换术。对比术前和末次随访时X线片、MRI相邻节段退变情况。相邻节段退变定义为X线片上椎间隙高度丢失与术前相比大于10%，形成肉眼可见新生骨赘或原有骨赘增大，前纵韧带钙化；在MRI T2加权像上采用Miyazaki颈椎间盘退变分级方法观察相邻节段椎间盘退变情况。结果：随访20~64个月，平均38个月。末次随访时X线片上160个相邻节段中，8个下相邻节段因肩部X线遮挡而显示不清，符合条件的152个相邻节段中21个（13.8%）出现退变，其中Bryan Disc置换术组退变发生率为10.0%，ProDisc-C置换术组退变发生率为18.1%；47例患者获得了MRI随访，94个相邻节段中14个（14.9%）椎间盘退变分级加重1级，其中Bryan Disc置换术组退变加重发生率为12.5%，ProDisc-C置换术组退变加重发生率为22.7%。未出现相邻节段疾病。结论：颈椎人工椎间盘置换术后平均38个月随访相邻节段退变表现加重者不足15%，不同类型的假体对相邻节段退变的影响可能存在一定差异。

英文摘要:

  【Abstract】 Objective：To investigate the adjacent segment degeneration after single level cervical disc arthroplasty.Method：Patients received single level cervical arthroplasty in our institute were reviewed retrospectively.Up to October 2010，a total of 80 patients gained at least 20 months′ follow-up.There were 8 cases of C3/4，15 C4/5，49 C5/6 and 8 C6/7.41 patents received Bryan Disc cervical prosthesis and 39 received ProDisc-C prosthesis.Adjacent segment degeneration was evaluated on X-ray and magnetic resonance imaging（MRI） at preoperative and final follow-up.X-ray based adjacent segment degeneration included the presence of any of the following parameters：narrowing of disc space＞10%，new anterior or/and extended osteophyte formation，calcification of anterior longitudinal ligament.Cervical disc degeneration was evaluated according to Miyazaki′s grading system based on T2-weighted MRI.Result：The mean follow-up period was 38 months（range，20-64 months）.Of 160 segments at final follow-up，8 distal adjacent segments were excluded due to unavailability of X-ray，adjacent segment degeneration was observed in 21 of 152 segments（13.8%） based on X-ray findings.The rate of adjacent segment degeneration for Bryan disc group was 10.0%，which was lower than that of ProDisc-C group（18.1%）.47 patients gained MRI follow-up，and adjacent segment degeneration was observed in 14 of 94 segments（14.9%）.The rate of MRI-based adjacent segment degeneration for Bryan Disc group was 12.5%，which was also lower than that of ProDisc-C group（22.7%）.No adjacent segment disease developed at final follow-up.Conclusion：Less than 15% cases develop adjacent segment degeneration 38 months after cervical disc arthroplasty，and the effect may vary between different prosthesis.