Early Clinical Study of Dynamic Cervical Implant in Anterior Cervical Spine Surgery
|School||Dalian Medical University|
|Keywords||Dynamic cervical implant Cervical spondylosis Treatment outcomes Complications|
Objective: To observe the short term clinical outcomes of dynamic cervical implant inanterior cervical spine surgery in the treatment of cervical spondylosis, understand theimpact of DCI to the cervical activity, as well as to explore the reasons of postoperativecomplications.Methods: From October,2010to April,2012, my hospital applied23case of DCItreatment of cervical disease, thirteen of whom are males. Among these cases, there are9cases with spondylotic myelopathy,6cases with spondylotic radiculopathy, and8cases with mixed cervical spondylosis.Using neural function evaluation and imagingevaluation to evaluate the curative effect of the surgery.Nerve function assessmentquestionnaire answer form on the VAS score, JOA score and NDI scores were collectedand compared preoperative and postoperative draw statistically significantimprovements;The imaging evaluation extract single level DCI cases of implantation,all patients were given CT,MRI examination, AP and Lateral X-Rays aswell as extension-flexion views to get the single and overall range ofmotion(ROM),and to exclude cases with any of associated problems as follows: severedegenerative signs, acute infection, osteoporosis, and so on. Postoperative prosthesisposition, clearance angle, gap height, with or without displacement and heterotopicossification, changes in the ROM of the surgical segment, compared with thepreoperative difference whether statistically significant.Results: All the patients got timely follow-up, the span of which averaged at14.5months(4-48months).Neurological evaluation: JOA function score preoperative8.3±1.1points, the last follow-up of15.2±3.1points, with an average improvement of6.9points, a statistically significant difference (P <0.05); neck VAS score preoperative8.0±0.6points, the last follow-up2.8±2.4points, with an average improvement of5.2points(P <0.05); DNI ratings score preoperative40.1±1.6points, the last follow-up of18.3± 2.2(P <0.05);Compare single segment DCI into the DCI integration into thepostoperative nerve function to improve the situation, both found no significantdifference (P>0.05). Single segment DCI placed in the imaging evaluation: into thesegment ROM preoperative5.71±4.28°, the end of the follow-up of4.9±0.68°(P>0.05) on segment ROM preoperative10.23±7.36°, the last follow-up of8.95±6.21°(P>0.05), close to under-segment ROM surgery before8.42±3.75°, the last follow-upof8.32±3.96°(P>0.05), cervical total activities of the degree of preoperative43.2±18.71°, the last follow-up of43.2±13.73°(P>0.05), these were not statisticallysignificant; lateral cobb angle was3.71±4.53°, the last follow-up,8.52±4.25°, anaverage increase of4.81°, the difference was statistically significant (P <0.05);postoperative follow-up clinical The symptoms were significantly improved, only onecase of lower limb symptoms is slow, and found a false body shift slightly forward(about1mm), part of the prosthesis over the leading edge of the vertebral body. Theproliferation of10patients with vertebral osteophytes absorption. Five cases the trailingedge of heterotopic ossification(HO) formation.Conclusion: DCI treatment of cervical disease early outcome satisfactory, improvementof neurological function, the surgical technique retains the flexion and extension of thesurgical segments to limit the excessive activity of the intervertebral slow down thedegeneration of adjacent segments to limit the rotation function, strengthen the stabilityof the intervertebral elastic front opening maintain vertebral height and correct thekyphosis, the leading edge of the barb structure closely fit with the upper and lowervertebrae, ensure the stability of the intervertebral contribute to stress dispersion; DICalso has shortcomings, poor compliance of the rigid material cannot be close fit withupper and lower bony endplate, resulting in part of the stress is unevenly distributed,local instability, may induce the occurrence of complications such as heterotopicossification(HO), and product specifications are less than normal, existing modelscannot fully meet the needs of the Chinese race.