title: [Preliminary clinical outcome of three-level artificial disc replacement with PRESTIGE LP for cervical disc degenerative disease].
abstract: OBJECTIVE
  To review the literature about the multiple level artificial disc replacement and investigate the preliminary the clinical outcome of the first case in China applying three-level PRESTIGE LP artificial disc replacement for cervical disc degenerative disease.
  
  
  METHODS
  In April 2009, one female patient aged 44 years old was treated. She was diagnosed as disc protrusion at the C4, 5, C5, 6, and C6, 7 level. She had paresthesia, decreased muscle strength and positive pathological reflex in her left upper extremity. The neck disability index (NDI) was 43. The visual analogue scale (VAS) of the neck and the upper limb was 6.6 and 8.1, respectively. SF-36 physical and psychological score was 28 and 36, respectively. The surgery was performed via routine anterior cervical approach. After complete decompression of three segments, prostheses were implanted from the cephalic to the caudal end under radiographic monitoring. The patient was followed up 1 and 3 months after operation, respectively.
  
  
  RESULTS
  The time of operation was 220 minutes and the blood loss during operation was 270 mL. The incision healed by first intention. There was no occurrence of complications such as aggravation of nerve symptoms, hoarse voice, difficult in swallow, and cerebrospinal fluid leakage. At 3 months after the operation, the patient had pain relief, muscle force recovery and improvement of life quality. X-ray films showed that the sequence of cervical vertebra was well-maintained, there was no loosening and displacement of prosthesis, and the position and function were good. NDI was decreased to 7, indicating that the limitation was mild. The VAS of the neck and the upper limb was 0.5 and 0.6, respectively. SF-36 physical and psychological score was 48 and 53, respectively. The result of operation was graded as excellent according to Odom's criterion. The patient went back to her job.
  
  
  CONCLUSIONS
  Three-level PRESTIGE LP artificial disc replacement for cervical disc degenerative disease has satisfactory preliminary clinical results. However, more clinical case studies and longer clinical follow-up are needed to confirm its therapeutic effect on multi-level disc disease.
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R. China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Rui
authors.initials: R
authors.lastname: Shi
authors.forename: Xi
authors.initials: X
authors.lastname: Liu
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Zhao
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Quan
authors.initials: Q
authors.lastname: Gong
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zeng
authors.forename: Yueming
authors.initials: Y
authors.lastname: Song
authors.forename: Ying
authors.initials: Y
authors.lastname: Hong
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D016896:Treatment Outcome