Objectives: To evaluate the results of a single-level cervical disc herniated surgery using articulated intervertebral discs. Subjects and methods: Prospective, descriptive, uncontrolled study on 46 cases of herniated disc cervical spine surgery in Department of Neurosurgery, 175 Military Hospital from 11 - 2011 to 12 - 2016.
Trang 1ASSESSMENT OF RESULTS OF ARTIFICIAL DISC REPLACEMENT FOR SINGLE-LEVEL CERVICAL DISC HERNIATED TREATMENT
Nguyen Trung Kien 1 ; Vu Van Hoe 2
Nguyen Hung Minh 2 ; Quach Thi Can 3
SUMMARY
Objectives: To evaluate the results of a single-level cervical disc herniated surgery using articulated intervertebral discs Subjects and methods: Prospective, descriptive, uncontrolled study on 46 cases of herniated disc cervical spine surgery in Department of Neurosurgery,
175 Military Hospital from 11 - 2011 to 12 - 2016 Results: Average surgical time was 65.33 ± 16.38 minutes, no need for blood transfusion in the surgery with a little blood loss of 65.87 ± 26.21 mL The symptoms of neck pain and arm pain improved, after 12 months VAS neck and arms (1.73 and 1.30, respectively) was significantly different compared to before treatment (6.74 and 6.33, respectively) with p < 0.001 The index of decreased spinal function after surgery 12 months (8.86%) was significantly different from before surgery (43.52%) (p < 0.001) Myelosuppression in patients with myelophathy and myeloradiculophathy syndrome recovered well, before surgery was 10.55, after 12 months surgery was 16.12 Conclusion: Surgical treatment of articulated intervertebral disc replacement for single-level cervical disc herniated had good results with short surgical time, less blood loss, good improvement of neck and arms pain, well restored spine function as well as medicine cabinet functions
* Keywords: Single-stage herniated disc; Artificial disc; Artificial disc replacement
INTRODUCTION
Cervical disc herniation is a disease
caused by degenerative cervical spinal
disc that compresses the nerve root or
cervical spine, with the second highest
incidence rate after lumbar disc
herniation The clinical symptoms of
cervical herniated disc are diverse and
plentiful depending on the location, type,
and extent of herniation [12]
Treatments for preserving the disc
herniation include resting, physiotherapy,
muscle relaxants, anti-inflammatory pain, nerve root injection Surgical treatment
is mentioned when proper medical treatment is ineffective, with a duration of about 6 weeks The purpose of surgical treatment is to release root and spinal cord compression by a herniated disc, ensuring the structure of the cervical spine to limit the process of progressive degeneration [2] Until now, the basic treatment method that has been widely applied is the removal of intervertebral discs, extractions, and joint welding
1 175 Military Hospital
2 103 Military Hospital
3 National Otorhinolaryngology Hospital
Corresponding author: Nguyen Trung Kien (drkienbv175@gmail.com)
Date received: 10/10/2019
Date accepted: 10/12/2019
Trang 2The introduction of replacement materials
for autologous bone has helped to minimize
painful complications in the area of the
bone, however, the treatment results are
still not reaching the ideal due to the partial
hardening of bone welding, exercise cervical
spine, increasing the risk of adjacent vertebral
diseases The technique of replacing the
artificial disc has been created in recent
decades, it has been effective in solving
the causes of the pathology, at the same
time maintaining the height of the burning
space, maintaining the physiological curve
of the spine, keeping the movement of the
vertebrae and has been shown to yield
positive yield positive results [3, 4]
Artificial disc replacement method for
treatment of cervical spinal disc herniation
has been applied in the country since 2009
and its effectiveness has been proved by
several reports However, up to now, no
domestic studies have focused on
single-stage herniated disc herniation Therefore,
we conduct the project with the aim:
Evaluating some clinical effects of surgical
treatment on single-spinal cervical herniated
disc using artificial disc
SUBJECTS AND METHODS
1 Subjects.
Patient was diagnosed with single-stage
spinal disc herniated disc, surgery to replace
articulated artificial disc in Neurosurgery
Department, 175 Military Hospital from
November 2011 to December 2016
* Selection criteria: Patients were diagnosed
to identify single-stage spinal disc herniation based on clinical criteria and magnetic resonance images, and have been replaced with DiscocervTM artificial disc replacement
* Exclusion criteria: Instability of the
cervical spine, infection of the anterior cervical area, osteoporosis (measurement
of bone density index T-score ≤ -2.5),
a history of surgery for herniated spine disc, no full research records Patients did not agree to participate in the study
2 Methods.
The prospective study, longitudinal follow-up, no control
* Research indicators:
- Results of surgery:
+ Operating time: From the time of skin incision to the end of the incision
+ Blood loss: Calculated by the amount
of fluid including irrigation water and blood collected at the end of the operation minus the amount of irrigation water during surgery
- Complications: Bleeding, organ damage
to the front neck, infection
- Comparison of pain level (neck, arm), index of decreased vertebral function, level
of marrow injury after treatment at the time of discharge, after 6 and 12 months compared to before surgery:
+ Pain level on a VAS scale
+ The index of cervical spine reduction (NDI), dividing the degree of cervical spine function by Vernon and Mior [5]
Trang 3+ The degree of bone marrow damage
was based on the Benzel JOA scale (1991)
in patients with cervical spondylosis syndrome
and bone marrow suppression syndrome
[6]
- Data analysis was based on SPSS
22.0 medical statistics software
RESULTS AND DISCUSSION
Research included 46 patients with a
single-stage spinal disc herniation who
underwent surgery to replace a total artificial
disc with an average age of 50.70 ± 10.97;
male: 43.47%; female: 56.53%, 37/46 patients
(80.43%) were re-examined after surgery
12 months, we obtained some results
as follows:
1 Results of peri-operation and early
complications
* The time of surgery, the amount of
blood lost during surgery:
The average surgical time was 65.33 ±
16.38 minutes (the longest time was
120 minutes, the shortest time was
45 minutes) We did not have to give any
patient blood during surgery with an
average blood loss of 65.87 mL (at least
50 mL, at most 150 mL) Pimenta studied
53 patients from 2002 to 2003, replacing
a single spinal disc with a 50-minute surgical
procedure and about 50 mL of blood loss
[7] In 2007, Ramadan replaced ancient
Discocerv disc pads for 17 patients,
with an average operation time of 67.1 ±
20.2 minutes (the shortest 35 minutes;
the longest 120 minutes) [8] Thus, in general, our research results were quite similar to the above studies
In fact, in addition to the pathological factors, the proficiency of the main surgeon and the assistant is also a factor that affects the time of surgery and the amount of blood lost during surgery Therefore, in the first time we applied the technique, we had longer operation time and more blood loss We also found that the support of microsurgical glasses made
it easier to observe lesions during surgery and the use of high-speed drill to address other causes of pinched nerve and spinal cord roots (overgrowth bones, ligaments, mucous hernia into the spinal canal ) were factors that facilitated the operation, shortening time and blood loss
During surgery, we did not experience bleeding complications, organ damage
or floor surgery Results of other authors also showed a low rate of complications, although the anterior neck area was quite complicated anatomically [7, 8, 9] Postoperative process, there was 1 case
of wound hematoma Patients with sore throat, shortness of breath, swollen neck
in the neck, had been reopened for surgical treatment After that, stabilize and leave the hospital without any sequelae O’Neill remarked that up to 35% of the surgical site hematoma occurred late on average about the sixth day after surgery, and he also recommended placing a drainage to prevent this complication [10]
Trang 42 Assessment of pain level according to VAS.
6.74
3.78
6.33
3.2
0
1
2
3
4
5
6
7
8
Figure 1: Comparison of VAS neck, arms before surgery and at discharge,
after 6 and 12 months
Before surgery, VAS scale measured
in neck and arms were 6.74 and 6.33,
respectively; at the time of discharge,
the VAS scale decreased to 3.78 at the
neck and 3.20 points at the arms At the
time of examination again after 6 and
12 months, VAS neck and arms continued
to decrease Comparison of VAS score
before surgery and at the time after surgery,
the difference was statistically significant
with p < 0.001 This demonstrated that
effective interventions, eliminating the
stimuli on the nerve root system helped
the signs of pain subside with time after
surgery However, in our research group
there were still some cases of patients
feeling pain, not very satisfied, neck VAS
index was still high (7 points) at the time
of discharge In our opinion, pain is a
symptom of rapid reduction after surgery but in some patients it is not possible to completely relieve the pain, which is not only a symptom of cervical herniation but also has many other causes such as degenerative spine, osteoporosis…
Zhao (2019) also gave results VAS of neck, arms before surgery (4.8 ± 2.3 and 5.4 ± 1.8) decreased by 1.7 ± 1.7 and 1.0 ± 1.7, respectively at the time of the final examination [9] Du J et al had replacement surgery of 26 discs for
25 patients, follow-up period an average
of 15.3 months, noticed improvement in pain immediately after the surgery and the next stage and he concluded: Artificial disc brings clinically good results and preserves some postoperative motions [11]
Trang 53 The improvement of the degree of NDI
15.74
43.52
0
5
10
15
20
25
30
35
40
45
50
Figure 2: Comparison of NDI before surgery and at discharge, after 6 and 12 months
Regarding improvement of cervical
function, before surgery, the average NDI
was estimated at 43.52 ± 1.57%, of which
the majority of patients were at the average
level of influence (NDI: 30 - 50%) The
degree of neck pain affecting the daily
activities and activities of the patient had
been resolved, the patient was no longer
uncomfortable due to the feeling of neck
pain, the daily activities had been performed
by themselves Clinical manifestations of
the previous days were now gone or greatly
improved After 12 months, we assessed
that the NDI decreased to 8.86 ± 6.05%,
mainly at the level of no effect This was
also a subjective assessment of the patient,
so it depended on many other factors
In our opinion, the index of NDI was not
only affected by the cervical herniation but
also many other influencing factors such
as joint degeneration of the torso bone,
the muscular cap, etc
According to Pimenta et al, NDI at the time of preoperative, after surgery 1 week,
6 months and 1 year was respectively 45%; 17%; 15% and 15% [7] Ramanda followed 17 patients after 3 months, NDI decreased from 25 ± 9 before surgery to
11 ± 9 [8] Thus, after surgery, the authors had shown that the analgesic effect after nerve compaction intervention improved the function of the cervical spine Our results were similar to those of the above authors’ researches, assessed at the time
of discharge, after 6 and 12 months, the difference was statistically significant with
p < 0.001
4 Rehabilitation of marrow function
function on a JOA scale.
Evaluation of myelosuppression on an
improved JOA scale in patients with syndrome (n = 25) and radiculomyelophathy syndrome (n = 8) at 6 months (n = 33) and after 12 months (with 26/37 patients had re-examination), we had the results according to the following table:
Trang 6Table 1: Comparison of JOA scores before and after surgery 6 and 12 months
Comparing JOA scores before surgery with postoperation at 6 and 12 months, there was a statistically significant difference with p < 0.001
The group of myelophathy syndrome
and mixed syndrome had a clinical severity,
the clinical symptoms that made people
most worried were the awkward symptoms
in their hands and walking anhydrous
because of the foot feeling tense, heavier
than motor paralysis, difficulty urinating
The main reason was that the herniated
disc compresses directly into the spinal cord,
causing a level of spinal stenosis Early
disc herniation surgery resolved the cause
of spinal cord compression and gave good
results Our study showed a significant
improvement in myelosuppression after
6 months and the time of re-examination
of the majority of patients had a very good
recovery This reflected the correct diagnosis
of lesions and the effective treatment of
neuromuscular suppression However, in
the study, we still had 2 cases who were
in the group of re-examined patients after
12 months, did not see a clear recovery in
nerve function and still faced with many
difficulties in living Both cases were late
to the hospital, the medullary lesion on MRI
images was due to long-term compression
of the hernia Thus, in order to achieve
effective intervention, a thorough early
detection of symptoms was extremely
necessary Our results were similar to a
number of studies in the country and
abroad for very good results in bone marrow rehabilitation Le Trong Sanh (2010) with
the results of recovery from 12.76 ± 1.79
to 16.04 ± 1.88 at the last examination [1]
Du J et al showed a JOA score before surgery 7.5 ± 2.3 to 15.6 ± 4.3 after 15.3 months [11] Zhao’s (2019) results after
10 years followed-up, rehabilitation of marrow function improved from 12.8 ± 2.1
to 15.9 ± 1.1 [9]
CONCLUSION
Surgical treatment method of replacement
of articulated intervertebral disc for the 1-floor spinal disc herniation had good results in improving clinical manifestations The average time of surgery was 65.33 ± 16.38 minutes, there was no blood transfusion in the surgery with the average amount of blood loss was 65.87 ± 26.21 mL, there were no complications during surgery After surgery, improving symptoms of neck and arms pain: VAS of neck and arms after surgery 12 months compared with before treatment Good rehabilitation
of spinal function: NDI after surgery
12 months, markedly different from before surgery Myelosuppression very well and well, the JOA score before surgery was 10.55, after surgery 12 months averagely was 16.12
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