A Clinical Trial Of The Artificial Disc Replacement And The Anteriorcervical Decompression And Fusion For Cervical Spondylosis

BackgroundCervical spondylosis is the degeneration,strain of injury,inflammation,the combination of many factors such as the cervical intervertebral disc degenerative change and its secondary stimulus or oppression adjacent structures(nerve root,spinal cord,vertebral artery,sympathetic nerve,etc.),different degrees of symptoms or signs has become a serious harm to people’s physical and mental health and one of the diseases that affect the quality of life.Degeneration is the primary cause of cervical spondylosis happen “degeneration” is the body increased with the increase of age structure,metabolism and function of a recession.cervical intervertebral disc,cervical vertebra body and cervical vertebra joint degeneration,cause hernia of intervertebral disc degeneration and vertebral osteophyte formation,on the cervical spinal cord and nerve root compression,and then make the corresponding clinical symptoms of patients.cervical spondylosis at the general phy sical therapy,massage,family therapy and medication,relieve symptoms,to pass strict non-surgical therapies require surgical treatment of anterior cervical decompression fusion in the treatment of cervical spondylosis is the common procedure and domestic and foreign research shows that vacuun fusion in anterior portion in the spinal cord and/or nerve root compression, relieve the clinical symptoms,maintaining the height of cervical vertebra,immediate stability and promote bone graft fusion more satisfactory results are obtained.But a growing body of evidence shows that decompression and interbody fusion can lead to anterior portion adjacent segment degeneration accelration,broken nails,broken rod,surgical complications such as again.In recent years domestic and foreign scholars began to explore use cervical fusion technology to replace the traditional anterior decompression fusion.Cervical artificial disc replacement as a new type of fusion technology is increasing applied in clinical treatment,not only achieved satisfactory clinical effect,also can cause the delay of adjacent segment degeneration, postoperrative cervical spine biomechanics characteristics close to the physical stability. Objective:To compare the clinical effect of the single level artificial disc replacement(ADR) and the anterior cervicaldecompression and fusion(ACDF) for cervical spondylosis.Methods:A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrolled from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group(replacement group; n=32) and anterior cervical decompression and fusion group(fusion group; n=27). They were followed up at 7 days, 3, 6 and 12months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed. Results:The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores(P<0.05), while Japanese Orthopaedic Association Scores were decreased compared with preoperative scores(P < 0.05). There were no significant differences between two groups(P > 0.05). Range of motion of the replacement segment after treatment was(12.4±2.8)° in the replacement group, showing no significant differences as compared with before surgery(11.5±3.0)°(P > 0.05). No significant activity was found at 3 months after treatment in the fusion group. During follow-up, the range of motion in the adjacent segments was smaller in the replacement group than in the fusion group(P < 0.05). No significant difference in the range of motion in the adjacent segments was detected before and after treatment in the replacement group(P > 0.05), but significant differences in the range of motion were detected before and after treatment in the fusion group(P < 0.05). The range of motion was apparently increased after treatment Conclusion:Compare with anterior decompression and fusion, Cervical artificial disc replacement can not only improve the clinical symptoms, restore nerve function, but also can keep the activity and stability of the cervical replacement segmental. Moreover, it can retain normal motion of surgical segment and cervical lordosis, obtain good recent clinical curative effect.