Objective To study the cl inical appl ication of Mobi-C prosthesis in treatment of anterior cervical discectomy and artificial disc replacement (ADR). Methods Between January 2009 and June 2009, 20 cases of degenerative cervical disease were treated with anterior discectomy and ADR by Mobi-C prosthesis, including 13 cases of cervical disc herniation and 7 cases of cervical spondylotic radiculopathy, and 25 Mobi-C prosthesis were implanted. There were 8 males and 12 females, aged 29-54 years (mean, 45.2 years). The disease duration was from 4 days to 5 years (mean, 1.2 years). Affected segments of process included C3, 4 in 1 case, C4, 5 in 2 cases, C5, 6 in 7 cases, C6, 7 in 5 cases, C4, 5 and C5, 6 in 2 cases, and C5, 6 and C6, 7 in 3 cases. Radiographs were taken regularly, and cervical range of motion (ROM) on segments of disc replacements were measured. The functions of cervical spinal cord were evaluated by “40 score” system (COA) preoperatively, immediately postoperatively, and at follow-up. The qual ity of l ife was evaluated by neck disabil ity index (NDI) and visual analogue scale (VAS) score. Results All incisions healed by first intention. No perioperative compl ication was found. All cases were followed up 16.5 months on average (range, 14-18 months). There was no significant difference in cervical ROM of operatied segment between preoperation and follow-up duration (t=0.808，P=0.440). No heterotopic ossification was found at follow-up. COA score at last follow-up (38.20 ± 1.14) was significantly higher than preoperative one (32.10 ± 2.96) , (t=9.278，P=0.000) , and the improvement rate at last follow-up was 77.2% ± 5.4%. VAS score at last follow-up (3.20 ± 1.23) had significant difference when compared with preoperative one (5.10 ± 1.29), (t=10.585，P=0.000). NDI score at last follow-up (29.40 ± 4.55) had significant difference when compared with preoperative one (39.20 ± 3.80), (t=16.039, P=0.000). Conclusion A satisfactory short-term curative effect can be obtained by using Mobi-C prosthesis in treatment of anterior cervical discectomy and ADR.
Objective To evaluate the clinical effect of percutaneous laser disc decompression (PLDD) in the treatment of cervical disc herniation. Methods From March 2003 to December 2005, 47 patients with cervical disc herniation(96 cervical disc) were treated with PLDD. There were 25 males and 22 females with an average age of 56 years, ranging from 37 to72 years. The lesion were located at the levels of C3,4 in 20 discs, C4,5 in 27 discs, C5,6 in 31 discs, C6,7 in 18 discs. The laser fiber was introduced into the center of the herniated disc space by percutaneous puncture from anterior neck surface under fluoroscopic guidance. Laser reduced the intradisc pressure through the vaporization of disc nucleu. The adopted laser was semiconducted with a wavelength of 810 nm. Each laser output power was15 W with 1 s emission and 2 s interval. The total laser output power was decided depending on the degenerative degree of the disc and the reactive process of heat, ranging from 300 to 1 000 J.Results Of 47 patients,42 were followed up for 3 to 31 months (mean 13 months). The clinical evaluation was classified as excellent in 18 cases (42.9%), good in 14 cases (33.3%), fair in 6 cases (14.3%) and poor in 4 cases (9.5%). The general response rate was 90.5%. The excellent and good rate was 76.2%. No complications occurred. Conclusion PLDD can relieve the symptoms and signs of patients suffering from cervical disc herniation with less complication. The manipulation of PLDD is easy, safe and mini-invasive.
Objective To make a clinical analysis on the patients with triceps paralysis caused by cervical radiculopathy.Methods From May 1998 to November 2003, 15 patients (11 males, 4 females, aged 34-76 years) with cervical radiculopathy were analyzed retrospectively, who had no symptoms of the compressed pyramidal tract of the medulla. The affection occurred at C3,4 in 1 patient, at C4,5 in 9 patients and at C5,6in 5 patients. According to the Yamazaki classification, there were 4 patients with the paramedian disc protrusion, 5 with the lateral disc protrusion，4 with the uncovertebralosteophyte, and 2 with the superior articular process hypertrophy. All the patients complained of the unilateral shoulder weakness, especially on abduction. Muscle atrophy occurred when radiculopathy was serious. There was a radicular painin the shoulder, the scapular region, and the forearm. Some of the patients haddysesthesia but with no pathological reflex, symptoms of the pyramidal tract ofthe medulla or hyperreflexia of the tendon reflex on the neurological examination. Before operation, the triceps strength was 2.40±0.51, the scale of the nerve root symptoms was 7.60±1.45, and the width of the intervertebral foramina on MRI was 2.90±0.15 mm. Of the patients, 13 had undergone the anterior cervical discectomy, the uncovertebral joint recection, and uncoforaminotomy; 2 had undergone the posterior medial facetectomy and foraminotomy to decompress the nerve root. Results According the follow-up for 16-24 months averaged 19.4 months revealed that the pain was obviously relieved, the scale of the nerve root symptoms was 3.34 ± 0.62, the triceps strength was enhanced to 4.40 ± 0.74, and the width of the intervertebral foramina was 4.07±0.16 mm. There was a significant difference postoperatively when compared with preoperatively (Plt;0.01）. Conclusion The cervical radiculopathy is usuallyaccompanied by the cervical spondylosis myelopathy. It is rarely encountered that the disease happened alone with no symptoms of the compressed pyramidal tractof the medulla. The disease is related to the foraminal disc herniation, the foraminal osteophyte formation, and the processus articularis proliferation. The treatment of choice is resection of the osteophyte or the herniated disc, and decompression of the nerve root.
Objective To evaluate the therapeutic effect ofthe two-level cervical artificial disc replacements combined with the nearby segments fused for the multi-level disc herniations and to investigate their interaction during the treatment. Methods The patient undergoing surgery was diagnosed as having intervertebral disc herniations in the C3-7 intervertebral discs. During the operation, the C4-6 discs were replaced with two Bryan artificial discs while the C3,4 and C6,7 discs were removed, followed by the bone grafting and the Zephir instrumentation. The range of motion (ROM) was assessed before and immediately after operation by the flexion-extension radiography. The patient’s functional exercise began as early as 2 days after operation and lasted for 3 weeks, followed by immobilization for 3 months. Results According to the follow-up for 1 year and 2 months, the patientcould move his neck in all directions without pain. The spinal and neural symptoms were significantly alleviated. ROM was close to the normal level postoperatively.Conclusion Artificial disc replacement combined with bone grafting and fusion is a new way to treat multilevel disc herniations surgically, with good clinical results. Early cervical functional exercise followed byrestriction is an effective way to deal with the contradiction of motion and immobilization.
Objective To investigate the therapeutic effects of anterior approach set (AAS) versus posterior approach set (PAS) in treating multilevel cervical disc herniation of three or four segments. Methods Fifty-six cases of multilevel cervical disc herniation were retrospectively studied. Thirty-seven casesunderwent anterior approach, and discectomy, selectively partial corpectomy with bone grafting and plate fixing was performed (AAS group); 19 cases underwent posterior approach, and laminectomy with lateral cervical mass plate screw fixing was performed (PAS group).Results The followup periods were 6 months to 4 years and 5 months, averaging 2 years and 10 months in AAS group and 1 year and 5 months to 5 years and 1 month, averaging 3 years and 8 months in PAS group. JOA functional assessment and sagittal diameter of dural sac were not-statistically significant between two groups before operation (Pgt;0.05) andwere significantly larger in AAS group than in PAS group after operation (Plt;0.01). The improvement rate of AAS was significant higher than that of PAS (Plt;0.01). The number of complication in AAS were slight more than that in PAS.Conclusion AAS is obviously better than PAS in the therapeutic effects. The operation of anterior decompression with bone grafting and plate fixing is an indication of multilevel cervical disc herniation of three or four segments.
ObjectiveTo investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach.MethodsAccording to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C3, 4 in 2 cases, C4, 5 in 8 cases, C5, 6 in 9 cases, and C6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated.ResultsFull-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation (P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one (t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation (t=0.881, P=0.421).ConclusionFull-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
ObjectiveTo investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation.MethodsBetween December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C3, 4 in 2 cases, C4, 5 in 5 cases, C5, 6 in 9 cases, C6, 7 in 12 cases, and C7, T1 in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation.ResultsAll patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation (P<0.05). There was no significant difference between the time points after operation (P>0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation (t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae.ConclusionFor the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure.