| The cervical spondylosis is a serious cervical spinal degenerativedisease,also very common in adult.In early stage we take conservativeways to treat the disease,operation is the last choice.Cervical spineanterior decompression and bone grafting fusion procedure is an effectivemethod to treat cervical degenerative disease,but the motion of adjacentincreases when interbody fuse,which causes the adjacent segmentdegeneration or aggravate the primary degeneration.Cervical artificialdisc replacement (CADR) is a new technique to replace the affected discand exercise its function, with reservation of the movement ofcorresponding segment, and decrease adjacent degeneration.The intervertebral foramen dimension possesses decisivesignificance for the diagnosis of cervical intervertebral foramen stenosisand cervicalspondylotic radiculopathy. The study on the morphometricchange of cervical intervertebral foramen has important significancebecause it is closely related to biomechanical characters and is one of theimportant indexes for evaluation of clinical efficiency. However there isno report whether the artificial disc can fulfill all function of the disc, orhave side effect on the adjacent disc or intervertebral foramen, especiallythe inferior one.The study is to perform from the following three aspects: (1) Toprovide data for experiment and clinic through the observation andcomparison of the cervical intervertebral foramen of cadaver,CT andadults' X ray. (2) To explore the morphometric change of superior (C3/4,C4/5) intervertebral foramen under different status and loading amonggroups of (C4/5,C5/6)ADR, normal disc, discectomy, anterior fusion. (3) Tocompare the morphometric change of superior (C3/4,C4/5) intervertebralforamen after (C4/5,C5/6)ADR and anterior fusion at same level. Chapter One: The Anatomic and imageologic Measurement of theCervical Intervertebral ForamenObjective To provide data of anatomy and imageology for theresearch of the biomechanical effect on the superior cervical foramen andthe diagnosis and treatment of clinical cervical diseases.Method To observe the height,width of C2～T1 cervicalintervertebral foramina from 18 antiseptic adult cervical speciments byanatomy,CT and X-ray examination. All the data are analyzed withSPSS13 (α=0.05). There is statistical significance when P is smaller than0.05.Result The intervertebral foramen average height and width of theintegrity group without loading were 7.36±0.48mm and 5.35±0.52mm.The intervertebral foramen average height and width from X-ray were9.60±0.58mm and 6.85±0.78mm. The intervertebral foramen averageheight and width from CT were 7.42±0.50mm and 5.41±0.52mm. Thereis statistical significance in the Paired-Sample T test of the averagewidth and average height of intervertebral foramen between anatomyand X-ray examination. There is statistical significance in thePaired-Sample T test of the average width and average height ofintervertebral foramen between CT and X-ray examination.But there isnot statistical significance in the Paired-Sample T test of the averagewidth and average height of intervertebral foramen between anatomyand CT examination.The percentage of height of intervertebral foramenbetween anatomy and X-ray examination is 78％and of width is 80％.The measuremen numerical value of cadaver from anatomy and CT issmaller than that from X ray. They are analyzed correlation of theaverage width and average height of intervertebral foramen amonganatomy,CT and X-ray examination.Conclusion The measuremen numerical value of cadaver fromanatomy and CT is smaller than that of X ray. They are positive correlation among anatomy,CT and X-ray.CT is convenience andexactitude in measurement the intervertebral foramen height and width.Chapter Two: The Biomechanical Research of the MorphometricChange of the Adjacent Superior Cervical Intervertebral ForamenAfter Two Level Artificial Disc ReplacementObjective We explore the cervical intervertebral foramina height,width change of C3/4,C4/5 foramen pre- and post C4/5,C5/6 discetomy,CADR, and the intervertebral fusion in all the five different test conditionand different loading in order to provide theoretical basis for clinic.Method 11 fresh cervical spinal specimens(C1-T1) obtained fromyoung adult cadavers during the biomechanical measurement, Specimensare divided into integrity group, discectomy group, artificial discreplacement group and intervertebral fusion group of C4/5,C5/6. TheC3/4,C4/5 intervertebral foraminal dimension including height and widthand the range of variety(ROV) among the four groups before and afterloading are measured with migration sensor in each group duringdifferent movement and loading. All the data are analyzed with SPSS13.There is statistical significance when P is smaller than 0.05.Result The cervical intervertebral foramina height, width change ofC3/4,C4/5 foramen pre- and post C4/5,C5/6 discetomy, CADR, and theintervertebral fusion in all the five different test condition and differentloading are as followed: there is no difference between the integrity groupand discectomy, integrity and CADR, discectomy and CADR groups inall the five different test condition(P＞0.05). There is significantdifference between integrity and fusion group, discectomy and fusiongroup, artificial disc replacement and fusion group(P＜0.05), we find thatthe ROV of superior intervetebral foramen height and width in fusiongroup is bigger than in other groups(P＜0.01) and in artificial disc replacement group is similar to that in the integrity group. The C3/4,C4/5intervetebral foramen height and width of the integrity group, thediscectomy, CADR and intervertebral fusion group increasedsignificantly during flexion and contralateral bending (P＜0.01). whiledecreased significantly during axial, extension and ipslateralbending(P＜0.01).Conclusion 1,The first time to compare the effect on the adjacentsuperior inter-foramina among the CADR, discectomy and intervertebralfusion group with the biomechanic method.we find that the ROV ofsuperior intervetebral foramen height and width in fusion group is biggerthan in other groups(P＜0.01) and in artificial disc replacement group issimilar to that in the integrity group.The results initial prove that CADRaccords with the cervical normal desire of vitodynamics and providetheoretical basis for clinical CADR.2,Dimension of adjacent superiorcervical intervetebral foramen in fusion group variated greatly andthis is probably one of causes which can lead to cervical degeneration oraccelerated degeneration. 3,Dimension of adjacent superior cervicalintervetebral foramen increased significantly during flexion andcontralateral bending(P＜0.01)while decreased significantly during axial,extension and ipslateral bending(P＜0.01).4,Dimension of inferiorcervical intervetebral foramen changes with the change of loading. Chapter Three: The Clinical Research of the Morphometric Changeof the Adjacent Superior Intervertebral Foramen After Two LevelArtificial Disc ReplacementObjective To observe the clinical results of the patients whoaccepted the Brayn artificial disc replacement and cervical interbodyfusion and analysis the effect on the adjacent inferior cervicalintervertebral foramen.Method 35 cases of C4/5,C5/6 prolapse of intervertebral disc whoaccepted the artificial disc replacement and the intervertebral fusion arefollowed from 1998 to 2006. 35 cases are divided into three groupsaccording to the way of operation and time as followed:the group ofartificial disc replacement,.the first group of intervertebral fusion and thesecond group of intervertebral fusion, the score of JOA, the rank ofOdom, the X-ray film of pre-operation and 6, 12, 24 months, 5yearspost-operation are collected. The clinical effect are evaluated throughanalyzing the score of JOA and the rank of Odom with the paired-sampleT test and chi-square test. The intervertebral disc height, the height andwidth of intervertebral foramen are measured directly on the film inoblique position at different period, and calculate the ratioR1, R2, Rbetween the height, width of foramen, the intervertebral disc height andthe vertebral height. All the data are analyzed with SPSS 13.Result (1) There are significant difference between pre-operationand different period post- operation(P＜0.01). The score of JOA and therank of Odom increased significantly in different period post- operationin the three group. There are not difference in 6 months post- operation inscore of JOA and rank of Odom between the group of artificial discreplacement and the first group of intervertebral fusion(P＞0.05). Thereare not difference in 12 months post- operation in score of JOA and rankof Odom between the group one and two of intervertebral fusion(P＞0.05). The score of JOA and rank of Odom decreased in 5 years post- operation and there are difference between 5 years and 12,24months post- operation(P＜0.01)in group two of intervertebral fusion.(2)There are not difference of R1,R2,R between pre-operation anddifferent period post- operation(P＞0.05) in the group of artificial discreplacement and the group one. There are not difference of R1,R2,R between pre-operation and 12,24 months post- operation(P＞0.05) inthe group two. There are difference of R1,R2,R between 5 years and12,24 months post- operation(P＜0.01)in group two.Conclusion 1.The recent curative effect is comparatively good inthe cervical artificial disc replacement and anterior intervertebralfusion, and there is no obvious influence on adjacent superiorintervertebral foramen.2. Adjacent superior intervertebral foramenbecomes smaller in middle-long period in anterior intervertebral fusion,and it may be one of causes of cervicalspondylotic radiculopathy.3. Themiddle-long curative effect in CADR need advanced observation. |
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