BACKGROUND:Anterior cervical discectomy and fusion surgery is a good choice for repair of degenerative cervical disc herniation, but it is reported that fusion can affect the exercise of cervical neighboring stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration.
These two methods which applied in cervical degenerative intervertebral disc herniation stil remain controversial. OBJECTIVE:To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS:Total y 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month fol ow-up were included and retrospectively analyzed. These patients were divided into replacement group (n=21) and fusion group (n=27) according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or al ogeneic fibularing. They were fol owed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the fol ow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association (JOA) score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION:During the final fol ow-up, the fusion rate in fusion group was 93%(25/27). Comparisons between groups:at the 1 week and final fol ow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were al lower than those before treatment;the Japanese Orthopaedic Association scores were higher than those before treatment (P<0.05). In the final fol ow-up, the visual analog scale scores of neck and upper limbs and cervical dysfunction index were al lower than those after one week of treatment, and the Japanese Orthopaedic Association scores were higher than those after one week of treatment (P<0.05). There were no significant differences in the above indicators at each time point between these two groups (P>0.05). The cervical activity and surgical segmental motion after cervical disc replacement were significantly higher than those in the fusion group;the difference was statistical y significant (P<0.05). There were no serious complications in these two groups. There was no significant difference in the incidence of complications between these two groups (P>0.05). These results suggest that the artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single cervical disc herniation have the same effect in terms of patients’ symptoms mitigation. With respect to fusion technique, artificial disc replacement surgery has the advantage of maintaining cervical stability and activities of replacement segments.

Objective To investigate the effect and prognosis of anterior posterior surgery combined with internal fixation on treatment of patients with severe idiopathic thoracolumbar scoliosis.Methods A total of 60 patients with severe idiopathic thoracolumbar scoliosis were randomly divided into two groups.The anterior and posterior group was treated with anterior and posterior internal fixation,and posterior group was treated with posterior combined with internal fixation.Effect,preoperative and postoperative indicators and condition during follow-up were observed.Results There were significant differences in operation time,blood loss,length of stay between two groups (P<0.05).There was no significant difference of fusion segments between two groups (P>0.05).There were significant differences in the main bending angle Cobb,kyphosis and trunk shift between two groups (P<0.05).There were no significant differences in the final follow-up Cobb angle loss,the degree of kyphosis loss,the correction rate of Cobb angle and the correction rate of kyphosis between two groups (P>0.05).Conclusion Anterior combined with posterior internal fixation is similar to posterior internal fixation in treatment of patients with severe idiopathic thoracolumbar scoliosis,but the operation time and hospital stay are shorter by posterior internal fixation,and the amount of bleeding is greater and the risk is higher.

Objective To investigate the effect and prognosis of anterior posterior surgery combined with internal fixation on treatment of patients with severe idiopathic thoracolumbar scoliosis.Methods A total of 60 patients with severe idiopathic thoracolumbar scoliosis were randomly divided into two groups.The anterior and posterior group was treated with anterior and posterior internal fixation,and posterior group was treated with posterior combined with internal fixation.Effect,preoperative and postoperative indicators and condition during follow-up were observed.Results There were significant differences in operation time,blood loss,length of stay between two groups (P<0.05).There was no significant difference of fusion segments between two groups (P>0.05).There were significant differences in the main bending angle Cobb,kyphosis and trunk shift between two groups (P<0.05).There were no significant differences in the final follow-up Cobb angle loss,the degree of kyphosis loss,the correction rate of Cobb angle and the correction rate of kyphosis between two groups (P>0.05).Conclusion Anterior combined with posterior internal fixation is similar to posterior internal fixation in treatment of patients with severe idiopathic thoracolumbar scoliosis,but the operation time and hospital stay are shorter by posterior internal fixation,and the amount of bleeding is greater and the risk is higher.