Objective To review the l iterature about the multiple level artificial disc replacement and investigate the prel iminary the cl inical 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 positivepathological reflex in her left upper extremity. The neck disabil ity index (NDI) was 43. The visual analogue scale (VAS) of the neck and the upper l imb 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 cephal ic 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 compl ications 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 rel ief, muscle force recovery and improvement of l ife qual ity. 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 l imitation was mild. The VAS of the neck and the upper l imb 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. Conclusion Three-level PRESTIGE® LP artificial disc replacement for cervical disc degenerative disease has satisfactory prel iminary cl inical results. However, more cl inical case studies and longer cl inical followup are needed to confirm its therapeutic effect on multi-level disc disease.
Medical institutions, the last defense line for the medical treatment of coronavirus disease 2019, are crucial to avoid cross-infection in hospitals. And how to reasonably arrange patient visits and achieve early detection, early reporting, early isolation, and early treatment of patients with coronavirus disease 2019 and suspected cases at the same time is an important proposition. After the outbreak of coronavirus disease 2019, West China Hospital of Sichuan University continued to supplement and improve implementation details based on the three-level pre-examination and triage of infectious diseases, and established a three-level pre-inspection and triage management mechanism more suitable for coronavirus disease 2019, and successfully applied it. This article introduces the process and results of this outpatient three-level pre-examination and triage management optimization practice, aiming to provide an experience reference for the outpatient three-level pre-examination and triage in medical institutions.