Indexed on: 27 Jul '12Published on: 27 Jul '12Published in: Journal of spinal disorders & techniques
STUDY DESIGN:: This is a prospective study of artificial disc replacement combined with cage fusion for the treatment of multi-level cervical disc herniation. OBJECTIVE:: To evaluate the clinical outcome of Bryan cervical disc replacement combined with adjacent segment cage fusion in the treatment of patients with multi-level cervical disc herniation. To observe neurological improvement and interpret the radiographic findings. SUMMARY OF BACKGROUND DATA:: It is generally considered that one-level cervical disc replacement had an excellent intermediate clinical outcome. There was no final conclusion about the disc replacement for the treatment of multi-level cervical disc disease. The negative factors include possibile complication, high cost, and contraindication for disc replacement at one of the multi-segments. Disc replacement combined with adjacent segment cage fusion may be an option for the treatment of multi-level cervical disc disease for certain patients. METHODS:: There were 26 patients with multi-level cervical disc herniation who underwent single-level disc replacement and adjacent segment cage fusion. Of the patients, there were 17 male and 9 female, aged between 35 and 63 (mean age 47▒y). The herniated disc was located at C3-4, C4-5 in 1 case, C4-5, C5-6 in 11cases, C5-6, C6-7 in 7 cases, C4-5, C6-7 in 3 cases, and C4-5, C5-6, C6-7 in 4 cases. There were 12 cases with myelopathy and 14 patients with radiculopathy. The stabilization and the range of motion of implanted disc, the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated based on the JOA score (17 points), NDI (neck disability index) score and odom's criteria RESULTS:: All patients underwent single-level Bryan disc replacement and cage fusion on adjacent segment. The replacement segment and fusion segment were located next to each other among 23 patients. They were not next to each other in 3 cases. The follow-up was 24 months to 47 months. Definite stabilization was achieved for all Bryan discs. The average range of motion at replaced level was 9.5 degrees postoperatively. Solid fusion was achieved in all cage. There was no subsidence or displacement of cage. The JOA score (17 points) rose from 9.2 to 13.5 at final follow up. The NDI (neck disability index) was reduced from 40.8 to 28.5 at final follow-up. The clinical success (excellent/good/fair) based on Odom's Criteria were 84.6%. CONCLUSION:: Definite stabilization and satisfactory mobility were achieved after cervical disc replacement and cage fusion. This provides an effective option for the treatment of multi - level cervical disc herniation. The evaluation of high fusion rate of cage may need to accumulate more clinical cases.