Background Although anterior cervical discectomy and fusion (ACDF) is considered a gold standard approach for surgical management of cervical disc herniation syndromes, the use of dynamic cervical implant (DCI) provided a novel technique that aims at reconstruction of the anterior column while facilitating controlled neck motion and reducing stress across the facet joints. Aim of the work The objective of this study is to evaluate the clinical and radiological outcome of the DCI surgery in comparison to that achieved with ACDF using a conventional polyethylethylketone (PEEK) cage. Materials and methods This is a retrospective comparative study of 30 patients, with single level cervical degenerative disc disease (DDD), managed by the authors, either by DCI ( n = 15) or ACDF ( n = 15). Clinical and radiologic outcomes were assessed at 1, 3, and 12 months postoperatively. Clinical scoring systems included the Visual Analog Scale for Neck (VAS-N) and Arm (VAS-A), the Neck Disability Index score (NDI), as well as the evaluation of incidence of complications and neurological deterioration postoperatively. Radiographic evaluation included the assessment of postoperative cervical implant fusion, as well as evaluating the incidence of implant migration. Study duration was for two years from October 2016 to October 2018. Results Both the ACDF and DCI groups showed significant clinical improvement at 12 months postoperatively regarding the clinical outcome including VAS-A, VAS-N, and NDI values ( P = 0.001), while there was no significant difference on comparing between the two groups as regard the VAS-N, the VAS-A, and the NDI at 1,3 and 12 months after surgery. The ACDF group however showed better rate of implant fusion at 12 months postoperatively in contrast to the DCI group (80% and 26,7%, respectively) also, the ACDF group showed a lower rate of implant subsidence at 12 months after surgery ( P = 0.002). Besides, the incidence of implant migration was relatively high in the DCI group (20%). Conclusion The clinical results for DCI arthroplasty for the management of single-level cervical DDD are equivalent to those for ACDF; however, though providing an immediate dynamic stability, DCI is associated with a low fusion rate, higher rates of implant subsidence, and relatively high implant migration rate. Larger series and further studies should be considered with longer follow-up periods giving special attention to these issues.

中文翻译：

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单节段前路颈椎间盘切除融合术与动态颈椎植入物：临床和放射学结果

背景 虽然前路颈椎间盘切除融合术 (ACDF) 被认为是颈椎间盘突出综合征外科治疗的金标准方法，但动态颈椎植入物 (DCI) 的使用提供了一种旨在重建前柱同时促进颈部受控的新技术运动并减少小关节的压力。工作目的 本研究的目的是评估 DCI 手术的临床和放射学结果，与使用传统聚乙酮 (PEEK) 笼的 ACDF 相比。材料和方法 这是一项对 30 名单节段颈椎退行性椎间盘疾病 (DDD) 患者的回顾性比较研究，由作者通过 DCI ( n = 15) 或 ACDF ( n = 15) 进行管理。临床和放射学结果在 1、3、和术后 12 个月。临床评分系统包括颈部视觉模拟量表 (VAS-N) 和手臂 (VAS-A)、颈部残疾指数评分 (NDI)，以及术后并发症和神经功能恶化的发生率评估。放射学评估包括评估术后颈部种植体融合，以及评估种植体移位的发生率。研究时间为 2016 年 10 月至 2018 年 10 月，为期两年。 结果 ACDF 和 DCI 组在术后 12 个月的临床结果包括 VAS-A、VAS-N 和 NDI 值方面均显示出显着的临床改善（ P = 0.001），两组在术后1,3和12个月的VAS-N、VAS-A和NDI比较无显着差异。然而，与 DCI 组相比，ACDF 组在术后 12 个月显示出更好的种植体融合率（分别为 80% 和 26.7%），而且 ACDF 组在术后 12 个月显示出更低的种植体下沉率（ P = 0.002）。此外，DCI 组中种植体迁移的发生率相对较高（20%）。结论 DCI关节置换术治疗单节段颈椎DDD的临床效果与ACDF相当；然而，虽然提供即时动态稳定性，但 DCI 与低融合率、较高的种植体下沉率和相对较高的种植体迁移率相关。应考虑更大的系列和进一步的研究，并应考虑更长的随访期，特别注意这些问题。