| Objective: To compare the clinical efficacy of zero-profile anterior cervical interbody fusion(Zero-PACIF)and anterior cervical discectomy and fusion(ACDF)in the treatment of patients with single-segmental cervical spondylotic radiculopathy The impact of these two surgical methods on patients with postoperative adjacent spondylosis provides a clinical reference for orthopedic surgeons who perform anterior cervical fusion surgery for cervical spondylosis.Methods:(1)the data of 44 patients who met the diagnostic criteria,inclusion criteria,exclusion criteria and exclusion criteria of cervical Spondylotic radiculopathy and received MC+ fusion with single segment zero notch cervical fusion cage or single segment anterior cervical plate fusion in our hospital from January 2017 to September 2022 were selected,including 22 patients in zero notch cervical fusion cage MC+ fusion group(zero notch group).Anterior cervical plate fusion group(plate group,n=22).(2)the general data of the two groups were recorded: sex,age,operation segment and follow-up time.(3)Clinical efficacy evaluation:(1)the operation time and intraoperative blood loss were compared between the two groups.(2)Visual analogue(VAS)score and Japanese Orthopaedic Association(JOA)score were used to compare the pain relief and neurological function recovery before operation,after operation and the last follow-up.(3)The degree of postoperative dysphagia was compared by Bazaz grade of dysphagia.(4)Imaging evaluation:(1)the imaging indexes such as C2-C7 Cobb angle,vertebral height of fusion segment,bone graft fusion,adjacent segment ossification(ALOD),upper and lower adjacent intervertebral disc height and upper and lower adjacent intervertebral motion(ROM)were recorded by X-ray.(2)the imaging data were evaluated according to the Kellgren degeneration grading method of X-ray film and the Miyazaki intervertebral disc degeneration grading method of MRI film.By comparing the differences of various indexes between the two groups of anterior cervical surgery,and evaluating the imaging adjacent segmental degeneration(ASD)and symptomatic ASD of all patients before operation to 2 years after operation,the clinical effect of MC+ fusion with zero notch cervical interbody fusion cage was studied and analyzed.Results: All 44 patients were followed up for 2 years.There were no significant differences in gender and age between the two groups(P >0.05).The mean follow-up time of the zero notch group was 42.04±4.16 months and the mean follow-up time of the plate group was 41.95±4.06 months.The operative time in the zero notch group was significantly reduced compared with that in the plate group,with statistical significance(P < 0.05),but the intraoperative blood loss was not significantly different(P > 0.05).At the last follow-up,the neck pain VAS score and JOA score of the two groups were significantly improved compared with those before surgery(P < 0.05),but there was no statistical difference between the two groups.The grade of dysphagia in the zero notch group was significantly better than that in the plate group on the 5th day after surgery,and the difference was significant(P <0.05).Three months after the operation,all the dysphagia symptoms disappeared.At the last follow-up,the C2-C7 Cobb Angle was significantly improved compared with that before surgery(P < 0.05),but there was no significant difference between zero notch and plate group at each follow-up time point(P > 0.05).There was no significant difference between the zero notch group and the plate group(P > 0.05).The incidence of adjacent segment ossification in the zero notch group was significantly lower than that in the plate group at the last follow-up,and the difference was statistically significant(P < 0.05).At the last follow-up,the height of upper and lower adjacent intervertebral discs in 2 groups was significantly reduced compared with that before surgery,the difference was statistically significant(P < 0.05),but there was no significant difference between groups(P > 0.05).At the last follow-up,the upper adjacent intervertebral range of motion was significantly reduced,and the lower adjacent intervertebral range of motion was significantly increased,with statistical significance(P < 0.05).At the last follow-up,the bone fusion rate of all patients in both groups was 100%.At the last follow-up,a total of 1 patient(4.54%)in the zero notch group had imaging ASD,and the degeneration was located at the C4-C5 level,which was the upper adjacent segment of the surgical segment.A total of 4 patients(18.18%)in the plate group developed imaging ASD,with degeneration in C4-C53(13.64%)and C5-C61(4.54%),both located in the upper adjacent vertebra of the fusion segment.There was a significant difference in the incidence of imaging ASD between the zero notch group and the plate group(P < 0.05),and no symptomatic ASD occurred between the two groups,so there was no significant difference in the incidence of symptomatic ASD between the two groups(P > 0.05).Conclusion(s):(1)Anterior cervical zero notch interbody fusion fusion MC+ internal fixation fusion and traditional plate fusion have similar effects in the treatment of single level cervical spondylosis,and both can achieve satisfactory clinical efficacy.The zero notch group was superior to the plate group in reducing surgical time and postoperative dysphagia.(2)During the two-year follow-up,there was no significant difference between the zero notch group and the plate group in the improvement of postoperative cervical imaging indicators related to single level cervical spondylosis.However,differences in internal fixation methods between the two groups resulted in significant differences in the incidence of postoperative imaging ASDs during the follow-up period of this study,while no significant difference in the incidence of symptomatic ASDs.(3)The application of zero notch interbody fusion device MC+ internal fixation system can effectively reduce the incidence of ALOD in the short-term postoperative follow-up,which is better than the traditional plate group. |
PDF Full Text Request