| The cervical spondylosis is a serious cervical spinal degenerative disease, also very common in adult. In early stage we take conservative ways to treat the disease, operation is the last choice. Cervical spine anterior decompression and bone grafting fusion procedure is an effective method to treat cervical degenerative disease, but the motion of adjacent segment increases when interbody fuse, which causes the adjacent segment degeneration or aggravate the primary degeneration. Cervical artificial disc replacement (CADR) develops quickly recent years, the purpose of which is to replace intervertebral disc and bring it into play, keep adjacent segment movement and decrease adjacent segment degeneration.The size of cervical intervertebral foramen has deciding significance in diagnosis of intervertebral foramen stenosis and nerve root type of cervical spondylosis. With the development of the cervical artificial disc and the successful clinical use of the artificial disc, the number of the patient who accept the artificial disc increases quickly, but can all the artificial disc fulfill the function of the disc, and the side effect on the adjacent disc or intervertebral foramen, especially the superior disc is unreported.We searched cervical intervertebral foramen from three aspects in this study: (1) we observed and measured the cervical intervertebral foramen of cadaver, and compared them to provide data for the test later and the clinical study. (2) to reveal the effect to superior intervertebral foramen of CADR group,integrity group,discectomy group,anterior interbody fusion group in different load. (3)We observed the clinical therapy effects in the same period: 9 cases of C5/6 CADR, 30 cases of anterior bone grafting fusion and inner fixation, and compared the infection in the morphometric of the superior inter-foramina after two different operations. Objective We set this experiment to measure the size of cervical intervertebral foramen and to provide anatomic data for the research of the biomechanical effect on the superior cervical foramen and the diagnosis and treatment of clinical cervical diseases.Method 11 fresh cervical samples (C2～T1), cut off lateral and posterior muscle and soft tissue to measure maximum height and width of intervertebral foramen. To observe the height and width of C2～T1 cervical intervertebral foralnina from 11 adult cervical specimens .Compared with them (α=0.05).There was statistical significance when P was smaller than 0.05.Result(1) The height of cervical intervertebral foramen: C2-C3＞C7-T1＞C6-C7＞C3-CA =CA-C5 =C5-C6,there was no statistical difference among C3-C4,C4-C5 and C5-C6.(2) The width of cervical intervertebral foramen: CT-T1＞C2-C3＞C6-C7＞C3-C4＞C4-C5= C5-C6, there was no statistical difference between C4-C5 and C5-C6.(3) Intervertebral foramen average height and width of the integrity group without loading were 7.17±0.80 mm and 5.13±0.81mm. There was statistical significance between the mtervertebral foramen average width and average height.Conclusion(1) The height and the width of C2-C3 and C7-T1 intervertebral foramen are large comparatively.(2) The cervical intervertebral foramen height is larger than the width in average. Part two: The biomechanical research of the morphometric change of the superior inter-foramina after artificial disc replacementObjective To compare the intervertebral foramen height,maximum width change of C4/5 foramen before and post C5/6 discectomy, artificial disc replacement, and intervertebral fusion during different motion conditions, and to observe the biomechanical effect on superior foramen.Method 11 fresh cervical spinal specimens(C2～T1) obtained from young adult cadavers, during the biomechanical measurement, Specimens were divided into integrity group, discectomy group, artificial disc replacement group and intervertebral fusion group of C5/6. The load (100N) of neutrality and pure moments (1.00Nm) of axial, flexion, extension, ipsilateral bending and contralateral bending were applied on each group. The C4/c5 foraminate dimension including height and maximum width were measured with migration sensor. Compare with them (α=0.05).There was statistical significance when P was smaller than 0.05.Result(1) The superior inter-foramina height and maximum width decreased significantly during axial, extension and ipsilateral bending (P＜0.01), while increased significantly during flexion and contralateral bending (P＜0.01).(2) The ROV of C4/5 intervetebral foramen height and maximum width: the ROV of the fused group was greater than the discectomy group,the integrity group and the ARD group(P＜0.05);the ROV of the discectomy group,the integrity group and the ARD group were close(P＞0.05). Conclusion(1) The first time to compare the effect on superior intervertebral foramen among the ADR, discectomy and intervertebral fusion group with the biomechanical method: there is no difference of the C4/5 among ADR, integrity group and discectomy group, which supply the theoretical evidence to the application of ARD; the ROV of C4/c5 intervetebral foramen height and width obviously increased when intervertebral body is fused.(2) The size of the cervical intervertebral foramen variated greatly in different test positions: increase in the flexion and contralateral bending, and decreased in axial, extension, ipsilateral positions. Part Tree: The clinical observation of the morphometric change of the superior Inter-foramen after artificial disc replacementObjective To pursue the clinical results of the patients who accepted the Bryan artificial disc replacement, cervical interbody fusion, and analysis the effect on the superior intervertebral foramen.Method Collected 39 patients data, who accepted operation because of C5/6 cervical pathological change between Jan 1998 to Feb 2006, 39 cases divided into three groups based on operation type and the follow-up time: artificial disc replacement group, interbody fused group one and group two. With the phone call, letters and outpatient service, the R1,R2,R3 and their ROV(range of varieties),the score of JOA, the grade of Odom 3, 6months post-operation were collected and analyzed. The grade of Odom with X~2 test .All the data were analyzed with SPSS12.0 (α=0.05).Result(1)R1,R2,R3 follow-up: there were no obvious of R1,R2,R3 change in 3,6 months post-operation in three group, 12 months in group one and group two,24 months in group two(P＞0.05);Obvious change appeared in group two 5 years post-operation (P＜0.01).(2) ROV of R1,R2,R3 compartments : No obvious difference in 3 months and 6 months among three post-operation (p＞0.05); there was no statistical difference between group one and group two in 12 months post-operation (p＞0.05)(3) JOA score and Odom grade increased in three group in different periods post-operation (P＜0.01); there was no statistic differences of JOA score and Odom grade between ARE) gronp and group one (P＞0.05), so did group one with group two 12 months post-operation; JOA score and Odom grade tended to decrease in group two 5 years post-operation, compared with 12 months and 2 years post-operation of which, there were obvious differences (P＜0.01).Conclusion(1) The recent effect of cervical disc replacement and cervical intervertebral fusion are equal good, no obvious difference between them.(2)The superior intervertebral foramen becomes small in long-term follow up after cervical intervertebral fusion, which is a cause of cervical spine degeneration or speeding degeneration.(3)The long time effect of artificial disc replacement needs advanced research. |
