Preliminary clinical outcome of artificial cervical disc arthroplasty combined with adjacent segment fusion for the treatment of double-level cervical disc herniation

English Keywords:Cervical disc herniation  Double-level  Disc prosthesis  Cage

English Abstract:

  【Abstract】　Objective：To evaluate the preliminary clinical outcome of artificial cervical disc arthroplasty combined with adjacent segment fusion in the treatment of double-segmental cervical disc herniation.Method：A total of 13 cases with double-level cervical disc herniation undergoing single-level Bryan disc arthroplasty combined with adjacent segment fusion from May 2006 to November 2008 were reviewed retrospectively.Of the patients，there were 8 male and 5 female with age between 35 and 60 years（mean，47 years-old）.6 cases complained with myelopathy and 7 patients with radiculopathy.Disc herniation was noted at C4/5 and C5/6 in 8 cases，C5/6 and C6/7 in 3 cases and C4/5 and C6/7 in 2 cases.The segment with respect to arthroplasty and fusion respectively sited as adjacent level in 11 patients，and as interval level l in 2 cases.The clinical symptom and neurological function before and after surgery were evaluated according the JOA score（17 points），neck disability index（NDI） and Odom′s criteria.The stabilization and the range of motion of implanted disc，the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively.Result：The operating time was 90-160min with an average of 130min.The volume of blood loose was 50-400ml with an average of 130ml.No intraoperative and postoperative complication was noted.The follow-up was 6 moths to 3 years.At final follow up，the JOA score was 13.5±1.8 compared with 9.2±3.2 of preoperation（P<0.01），and the NDI was 28.5±5.4 compared with 40.8±4.7 of preoperation（P<0.01），the Odom′s criteria was rated as excellent in 6 cases，good in 3 cases，fair in 2 cases and poor in 2 cases.All Bryan disc achieved definite stabilization.The average range of motion for arthroplasty level was 9.5° of flexion-extension. Solid fusion was achieved in all levels brought by cage.There was no cage subsidence or displacement.Conclusion：Artificial cervical disc arthroplasty combined with adjacent segment fusion provides a new effective alternative for cervical disc herniation.The definite stabilization and maintained ROM can be achieved contemporarily which can ensure a good preliminary clinical outcome.