Clinical Analysis Of Cervical Artificial Disc Replacement For Single Segment Cervical Spondylotic Myelopathy

Objective:Through retrospective study,patients with single-level cervical spondylotic myelodathy(CSM)were treated with anterior discectomy and fusion(ACDF)and artificial disc replacement(CADR),respectively.Follow-up data were collected and analyzed.The short-term efficacy of CADR was evaluated by comparing with classical ACDF.Methods:Seventy patients with single-segment CSM in our hospital from October 2015 to October 2018 were divided into A and B groups.Classical ACDF was used in group A and CADR was used in group B,of which 38 cases were in group A and 32 cases were in group B.The general indexes,nerve improvement,cervical vertebra improvement and imaging data of different time periods before and after operation(admission,3 months,1 year,2 years after operation)were recorded and compared statistically.Results:1.The improvement of neurological function and JOA score were significantly improved in both groups before and after operation.At the last follow-up,the JOA score was 15.82(+0.83)and 15.94(+0.80),respectively.At the last follow-up,the improvement rate of JOA score was 86.8%in group A and 81.3%in group B,with no statistical difference(P>0.05).2.In terms of the improvement of cervical function,NDI scores decreased from 22.84(+2.17)and 22.94(+2.06)before operation to 9.03(+1.24)and 8.06(+1.04)at the last follow-up,with statistical difference(P<0.05);the excellent and good rates of Odom’s criteria were 92.1%and 93.8%,respectively,with no statistical difference(P>0.05).3.There was no significant difference in the change of C2-7cobb angle before and after operation and between groups(P>0.05).There was significant difference in the height of intervertebral space between the two groups after operation and before operation(P<0.05),but there was no significant difference in the height of intervertebral space between the two groups(P>0.05).The success rates of fusion were 78.9%,86.8%and 89.5%in group A after 3 months,1 year and 2 years follow-up.Two groups of patients reexamined by MRI showed that the decompression effect was satisfactory and there was no significant compression.4.In terms of operative complications,no serious surgical-related complications occurred during follow-up.In group A,4 patients had hoarseness and 1 had difficulty swallowing.In group B,2 patients had hoarseness and 1 patient had heterotopic ossification around the prosthesis after 3 months.Conclusion:At present,the academia still generally believes that CSM relieves the pressure mainly by surgery,CADR and ACDF can achieve good neurolysis and decompression effect.The difference is that,on the one hand,the existence of artificial intervertebral disc retains the motion ability of the diseased segment,and its design is more in line with human mechanics,which can delay the degeneration of adjacent intervertebral space to a certain extent;on the other hand,the scope of operation is more narrow,so the indications and taboos of operation should be strictly grasped when used.As one of the important alternatives to fusion,it can achieve good short-term results and is a better choice.