What might go wrong?
手术可能的失误？
All types of spine surgery, including artificial disc replacement, have certain risks and benefits. Weigh these as you gather advice and information. Be sure to discuss the possible risks of disc replacement with your spine surgeon.
包括人工椎间盘置换术在内的任何脊柱手术在有获益的同时均有一定之风险。当你获取建议以及信息时，应权衡利弊。一定要和你的脊柱医生讨论椎间盘置换手术可能之风险。
Medical complications arising from spinal surgery are rare but could include stroke, heart attack, spinal cord or spinal nerve injury, pneumonia, or possibly death.
由脊柱手术引发的医源性并发症少见，但可能包括中风、心脏突发事件、脊髓或者脊神经损伤，肺炎，或可能死亡。
However, information from the disc replacement operations shows a low rate of complications. There have been no reports of death, significant infection, or major neurological problems.
然而，来源于椎间盘置换术的信息表明并发症发生几率很低。还没有死亡、明显感染或者重大神经损伤的报告。
As with all major surgical procedures, complications can occur. This document doesn’t provide a complete list of the possible complications, but it does highlight some of the most common problems. Some of the most common complications are
如同所有外科大手术一般，并发症可能发生。这份资料并不完整罗列所有可能并发症，但它强调一些最常见的问题。一些最常见的并发症是：
· anesthesia complications
麻醉并发症
· thrombophlebitis
血栓性静脉炎
· infection
感染
· blood loss
失血
· nerve injury or paralysis
神经损伤或者瘫痪
· spontaneous ankylosis (fusion)
自发融合
· subsidence (sinking)
椎间隙下沉
· implant failure (need for further surgery)
植入失败需要再次手术
Anesthesia Complications
麻醉并发症
Most surgical procedures require that some type of anesthesia be done before surgery. A very small number of patients have problems with anesthesia. These problems can be reactions to the drugs used, problems related to other medical complications, and problems due to the anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.
大多数外科手术在术前需要某种麻醉。极少数患者出现麻醉问题。这些问题可能是药物反应或者药物并发症相关问题，以及麻醉医疗并发症。一定要和你的麻醉师讨论麻醉风险以及你所担心的事。
Thrombophlebitis (Blood Clots)
血栓性静脉炎
View animation of pulmonary embolism
Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation, but is more likely to occur following surgery on the hip, pelvis, or knee. DVT occurs when blood clots form in the large veins of the leg. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This is called apulmonary embolism.
血栓性静脉炎，有时称为深静脉栓塞，可能发生在任何术后，但更可能出现在髋关节、骨盆或者膝关节手术。当大腿大静脉形成血液凝固，深静脉血栓栓塞就发生了。这将会导致大腿肿胀以及触及发热，疼痛。如果静脉血栓分裂，它们可能游走到肺，它们停留在肺血管，阻断肺一个部位的血液供应。这称为肺栓塞。
(Pulmonary means lung, and embolism refers to a fragment of something traveling through the vascular system.) Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible after surgery. Two other commonly used preventative measures include
大多数外科医生重视预防深静脉栓塞。有许多方法可以减少深静脉栓塞风险，但可能最有效的方法是术后尽可能早的下床活动。其他两项常用预防性措施包括：
· pressure stockings to keep the blood in the legs moving
弹力袜促进下肢血液流动
· medications that thin the blood and prevent blood clots from forming
稀释血液以及抗血栓形成的药物
Infection
感染
Infection following spine surgery is rare but can be a very serious complication. Some infections may show up early, even before you leave the hospital. Infections on the skin’s surface usually go away with antibiotics. Deeper infections that spread into the bones and soft tissues of the spine are harder to treat and may require additional surgery to treat the infected portion of the spine.
脊柱术后感染少见但是非常严重的并发症。一些感染早期出现，甚至在你出院前。表皮感染通常可以用抗生素清除。波散到骨骼以及脊柱软组织的深层感染更难治疗，可能需要再次手术以治疗脊柱感染部位。
Blood Loss
失血
Cervical disc replacement surgery carries risks associated with operating from the front of the spine. Blood vessels that travel near the front of the spine may be injured during anterior cervical surgery.
颈椎间盘置换手术存在与脊柱前路手术相关的风险。分布于脊柱前的血管可能在前路颈椎手术中受损。
Nerve Injury
神经损伤
Any surgery that is done near the spinal canal can potentially cause injury to the spinal cord or spinal nerves. Injury can occur from bumping or cutting the nerve tissue with a surgical instrument, from swelling around the nerve, or from the formation of scar tissue. An injury to these structures can cause muscle weakness and a loss of sensation to the areas supplied by the nerve.
任何靠近脊髓腔的手术都可能潜在地导致脊髓或者脊神经的损伤。损伤可能发生在用外科器械碰擦或者切开神经组织，神经周围肿胀，或者疤痕阻滞形成。这些结构的损伤可能引起肌肉无力，神经支配区域感觉受损。
The nerve to the voice box is sometimes injured during surgery on the front of the neck. When doing anterior neck surgery, surgeons prefer to go through the left side of the neck where the path of the nerve to the voice box is more predictable than on the right side. During surgery, the nerve may get stretched too far when retractors are used to hold the muscles and soft tissues apart. When this happens, patients may be hoarse for a few days or weeks after surgery. In rare cases where the nerve is actually cut, patients may end up with ongoing minor problems of hoarseness, voice fatigue, or difficulty making high tones.
颈前路手术中有时会损伤喉返神经。当行颈前部手术，外科医生更喜欢颈左侧入路，因为喉返神经的走形比右侧更可预判。术中当使用牵引器来夹持肌肉以及软组织，神经可能被拉伸太长。当这种情况发生，患者可能术后或声音嘶哑几天或几周。在少数神经切断病例中，患者可能出现声音持续嘶哑，发声无力或者难以发出高音。
Spontaneous Ankylosis (fusion)
自发性融合
Some things can go wrong with any implant. In the case of artificial disc replacements for the cervical spine, sometimes the spine fuses itself, a process called spontaneous ankylosis. Loss of neck motion is the main side effect of this problem.
任何植入物可能出现问题。就颈椎人工椎间盘置换术而言，有时脊柱自我融合，称为自发性融合。颈部失去活动是这个并发症的主要副作用。
Bone may also form in the soft tissues around the vertebrae. For example, cartilage turns to bone or bone-like tissue. This process is called ossification. Ossification may not affect the implant or your final results in terms of motion or function.
在脊椎周围软组织中可能出现骨组织形成。例如，软骨化骨或者骨样组织。这种过程称为骨化。骨化并不影响植入物或者运动以及功能方面的结果。
Some patients are left with pain, numbness, and weakness. This can occur when there’s been incomplete neurologic decompression. In other words, there is still pressure on the spinal cord or spinal nerves.
有些病人遗留疼痛、麻木、无力。当神经减压不完全时会发生此种情况。换句话说，脊髓或者脊神经仍有压力存在。但是不排除术前神经根或脊髓变性致术后症状残留。
Subsidence (sinking)
下沉
Subsidence is another possible problem. The implant actually sinks down into the vertebral body above or below it. This results in a loss of the normal disc height. Neurologic compression with neurologic symptoms can occur.
下沉是另一可能的并发症。植入物可能陷入上下椎体中。这会导致正常椎间隙高度下降。伴随神经症状的神经压迫可能发生。
Implant Failure (need for further surgery)
植入物失败（需要翻修手术）
Over time, wear and tear just from the physical process of motion across a bearing surface can cause tiny bits of debris to flake off the implant. The body may react to these particles with an inflammatory response that can cause pain, implant loosening, and implant failure. So far, significant inflammatory reactions have not been reported for spinal artificial disc replacements. In rare cases, the artificial disc replacement can dislocate.
随着时间推移，物理运动引发的受力面上的磨损以及应力会使细小的碎片剥落植入物。植入物会对这些小碎片产生炎性反应，导致疼痛，植入物松动以及植入失败。到目前为止，人工椎间盘置换术还未报道明显炎症反应。极少数病例中，植入物可能移位。
What happens after surgery？
手术之后可能发生的事有哪些？
Most people spend one or two days in the hospital. You may require an extra day or two if for some reason you’re having extra pain or unexpected difficulty. Patients generally recover quickly after the artificial disc procedure.
大多数病人术后留院一到两天。如果你出现严重疼痛或者意外的不适等原因，你可能需要多住一到两天。通常患者术后恢复快。
You should be able to get out of bed and walk within a few hours. Move carefully and comfortably, and avoid extending your neck (bending backward). You may need to wear a brace or soft collar for a short while after the operation to support your neck muscles.
你能够在术后的几小时内下床步行。活动需要更外小心，避免伸展颈部背伸。你需要在术后短时间内戴一个支具或者柔软的颈围来支持你的颈部肌肉。
As you recover in the hospital, a physical therapist may see you one or two times each day until you go home. You’ll be shown ways to move, dress, and do activities without putting extra strain on your neck. Your therapist will help you begin a walking program in the hospital. You are encouraged to continue the walking program when you return home.
当你在医院康复时，物理治疗师会每天指导你一到两次，直到你出院。他们会告诉你在不增加颈部拉伸下步行、穿衣以及完成日常活动的方法。你的治疗师会在医院里帮助你开始的步行项目，直到你出院回家。
When you leave the hospital, there are very few activity restrictions. You should be safe to sit, walk, and drive. However, you should avoid lifting items for at least four weeks. Your surgeon will probably release you to return to work in two to four weeks. If your job requires moving and lifting heavy items, you may require a longer period of recovery. Your surgeon may give you the okay to do all your activities by the sixth week after surgery.
当你出院，基本没有活动限制。你需要注意坐、走以及开车安全。然而四周内你应当避免提物。你的外科医生会在两到四周内允许你工作。如果你的工作需要移动或者提起重物，你需要更长时间来恢复。你的外科医生可能在你术后6周左右允许完成你所有活动。
If you spend large amounts of time in front of a computer or other machine, you may need to change the height and angle of your work surface and/or the computer. Finding a position that puts minimal stress on your neck is important. You should avoid spending hours in one position reading, sewing, or doing other handwork. The therapist can help you find optimal positions and advise you about ways to stretch your neck muscles.
如果你花大量时间在电脑或其他机器面前，你可能需要改变工作台或者电脑的高度和角度。找一个给予颈部最小压力的姿势是重要的。你需要避免花时间用同一个姿势看书，缝纫或者做其他手工活。治疗室可以帮助你找到合适的姿势，建议你锻炼你颈部肌肉的方法。
康复
What should my recovery be like?
我的恢复应该是什么样的呢？
Your surgeon may prescribe outpatient physical therapy within one to two weeks after surgery. Plan on attending therapy two to three times each week for four to six weeks.
你的外科医生可能在术后一到两周安排门诊物理治疗。制定治疗计划4到6周，每周2到3次。
The first few visits include treatments to calm soreness and pain from the operation. Your therapist may apply gentle soft-tissue treatments such as massage. Ice and electrical stimulation are also commonly used to calm muscle spasm and to help take away any lasting pain.
前几次随访包括对术后出现的颈部静息酸痛进行治疗。你的治疗师可能会运用轻柔的软组织治疗方法，例如按摩。冰和电刺激也常用于缓解肌肉痉挛有助于消除持续性疼痛。
Your therapist will teach you how to protect your neck. You’ll learn ways to position your neck when you sleep, sit, and drive. And you’ll be shown ways to keep your neck safe during routine activities, such as getting in or out of bed, getting dressed, and washing your hair.
你的治疗师会告诉你如何保护你的颈部。你将会了解当你睡觉、坐位、开车时如何摆好你颈部的位置。也将会告诉你当你在日常活动中例如上下床、穿衣、洗头如何维持颈部安全。
Many patients are afraid to move the head and neck for fear of damaging or dislodging the disc. Using normal motion for everyday activities will not harm your new disc in any way. Your therapist will help you learn how to move your neck and show you any limits necessary.
许多患者害怕因活动头颈部而损伤植入的椎间盘。日常活动正常的颈部运动绝不会损伤到椎间盘。你的治疗师会告诉你如何活动颈部以及一些必要的限制。
Active treatments are used to improve flexibility, strength, and endurance. Gentle stretching exercises for the neck are commonly prescribed. You’ll begin a series of strengthening exercises to help tone and control the muscles that stabilize the neck and upper back. It is also important to build strength in your arms. Endurance exercises may include treadmill walking, swimming, or stationary biking.
积极治疗可用于提高柔韧性、强度以及持久性。通常会要求颈部轻度拉伸运动。你会开始一系列强化运动有助于维持健康状态，有助于调整位置颈部和上背部肌肉的稳定性。训练手臂力量也很重要。持久力训练包括跑步机行走、游泳、骑自行车。
When your symptoms are under control and you’re comfortable doing your exercises, your formal therapy sessions will end. You’ll continue your exercises as part of a home program.
当你的症状得到控制，运动时也感到舒适，你的正规治疗就会结束。你要继续把锻炼当成日常生活的一部分。
总结
Artificial disc replacement offers an alternative to cervical fusion for some patients who have chronic neck pain from degenerative disc disease. While fusion stops pain by eliminating movement in the problem spinal segment, ADR allows natural motion in the part of the spine where the disc is implanted. This is because the prosthesis is designed to imitate normal movement between adjacent vertebrae.
人工椎间盘置换术为椎间盘退变性疾病导致慢性颈部疼痛的患者需要颈椎融合提供又一选择。虽然融合术通过减少病变脊柱节段活动来消除疼痛，人工椎间盘置换术可以允许椎间盘植入节段的正常活动。这是因为人们以模仿相邻脊椎正常活动来设计假体。
A successful result means that your painful symptoms are better but not necessarily perfect. You can expect to have significantly less neck pain and greatly improved function with the operation. You can expect to discontinue the use of strong medications.
好的手术结果意味着你的疼痛症状获得改善，但不一定彻底消失。通过手术你期望明显减少颈部疼痛，明显改善功能。你可以停止使用强烈的镇痛药物。
But remember, no one can guarantee that you’ll be free of pain or that your spine will be totally flexible after this type of surgery. The idea that preserving motion will decrease adjacent segment degeneration hasn’t been proven yet. Long-term results (10 or more years) are unavailable.
但请记住，没人可以保证你会没有疼痛又或者你的脊柱在术后会完全充满弹性。坚持运动会减少相邻节段退变的想法也还未被证实。未获得十年或更久的长期随访结果。
翻译：郭晓峰（南通大学2016届骨科研究生）
校对：保国锋
保国锋，南通市第一人民医院脊柱外科，副主任医师，硕士生导师、医学博士。江苏省“333高层次人才”培育对象、南通市医学重点人才、南通市“226高层次人才”培养对象。社会兼职：江苏省医学会骨科分会创伤学组委员、江苏省中西医结合学会骨科分会委员、北美脊柱外科学会(NASS)会员、南通市中西医结合学会骨科分会委员。擅长颈肩腰腿痛、脊柱脊髓损伤、脑瘫等手术治疗。2011年、2014年、2016年曾在澳大利亚Latrobe大学、德国OberlinHaus医院、德国科隆大学医院和韩国首尔国立大学医院（SNUH）研修脊柱外科。
门诊时间：周五全天
患者指南，图文并茂，
分门别类，构思巧妙。
深入浅出，中英对照，
医患携手，共同探讨。
能力有限，时间仓促，
错误难免，诚惶诚恐。
恳请各位，留言指导，
以利再版，更加周到。
联系客服
