General Session: MIS-3
Presented by: H-K. Chang - View Audio/Video Presentation (Members Only)
H-K. Chang(1,2), J-C. Wu(1,2), P-Y. Chang(1,2), T-H. Tu(1,2), L-Y. Fay(1,2), W-C. Huang(1,2), H-C. Chang(3), H. Cheng(1,2)
(1) Taipei Veterans General Hospital, Neurological Institute, Taipei, Taiwan, Republic of China
(2) National Yang-Ming University, School of Medicine, Taipei, Taiwan, Republic of China
(3) Kaohsiung Veterans General Hospital, Surgery, Kaohsiung, Taiwan, Republic of China
Object: Several Us-Fda Trials Have Demonstrated The Success Of Cervical Disc Arthroplasty (Cda) In Patients With One- Or Two-Level Cervical Degenerative Disc Disease (Ddd) Causing Radiculopathy, Myelopathy, Or Both. However, For Patients With Myelopathy Who Also Had Increased Intramedullary Signal Intensity (Iisi) On A T2-Weightedmagnetic Resonance Image (Mri), The Effectiveness And Safety Of This Dynamic Construct Of Cda Was Unclear. This Study Aimed To Evaluate The Outcomes Of Cda For Patients With Iisi On Their Pre-Operative T2-Weighted Mri.
Methods: Consecutive Patients Who Received One-Level Cervical Arthroplasty For Symptomatic Cervical Ddd That Were Refractory To Medical Treatment Were Included And Retrospectively Reviewed. Patients With Increased Intramedullary Signal Intensity (Iisi) On Pre-Operative T2-Weighted Mri Were Compared To Those Without Iisi (Non-Iisi). Clinical Outcome Parameters Including Visual Analog Scale (Vas), Neck Disability Index (Ndi), Japanese Orthopedic Association (Joa), And Nurick Scores Were Analyzed. Radiographic Studies Included Dynamic Lateral Radiography And Mri.
Results: A Total Of 91 Patients Were Analyzed (22 Patients In The Iisi Group And 69 Patients In The Non-Iisi Group). The Mean Follow-Up Was 30.0Months. Pre-Operation, The Demographic Data Were Similar Between The Two Groups, Except That The Isi Group Was More Male Predominant (81.8% Vs. 47.8%, P=0.005). Post-Operation, All The Clinical Outcomes, Including Vas, Ndi, And Joa In The Iisi Group Demonstrated Significant Improvement Than That Of Pre-Operation. Nurick Scores Of Patients In The Iisi Group Also Improved Significantly After Surgery. The Iisi Group Had Similar Clinical Outcomes To The Non-Iisi Group, Except That The Joa Scores Were Generally Worse In The Iisi Group. Follow-Up Mri Demonstrated Significant Regression Of The Length Of Iisi(10.1±7.58 Vs 4.9±4.45Mm, P=0.009). Both Groups Had Preserved Motion At The Indexed Levels Of Cda.
Conclusions: Both Clinical And Radiological Outcomes Improved (The Average Length Of Iisi In The Cervical Spinal Cord Became Shorter) Significantly After Cda In Patients With Myelopathy. Therefore, Cda Is A Safe And Effective Option For Patients With Cervical Myelopathy Even When There Is Iisi On The Pre-Operative T2-Weighted Mri.