前路手术治疗下颈椎退变性不稳的临床分析

Clinical analysis of degenerative instability of lower cervical vertebrae after anterior surgery

目的总结颈前路手术治疗下颈椎退行性不稳的经验,并探讨手术适应证。方法回顾性分析13例影像学上有颈椎不稳、伴有体位性症状病人的临床资料。采取前路颈椎不稳节段椎间盘显微切除加椎间植骨融合、钢板内固定术。结果随访13例,时间6个月~2年,平均9个月。病人症状均明显改善,11例症状完全消失,2例偶有颈背部酸胀感,融合节段均获得骨性愈合。手术前后JOA评分有统计学差异（P〈0.01）。结论对于影像学上出现颈椎退行性不稳同时伴有颈椎体位性症状,且两者可相互解释的病人,通过颈前路行不稳节段的融合术可获得良好的治疗效果。

Objective To summarize the experiences of anterior surgery for degenerative instability of lower cervical vertebrae and explore the surgical indications. Methods Clinical data of 13 patients with instability of lower cervical vertebrae in imaging and postural symptoms were analyzed retrospectively. All the patients received intervertebral disc microdiscectomy in cervical instability segments via anterior approach, intervertebral implanted bone fusion and internal fixation with steel plate. Results All the patients were followed up for 6 months to 2 years with a mean period of 9 months. The symptoms of 13 patients were improved significantly including symptom disappearance in 11 and occasional nuchal pain in 2. The bone union was observed in fusion segments. There was significant difference in JOA scores before and after surgery （P 〈 0.01）. Conclusions For the patients with degenerative cervical instability in imaging and cervical postural symptoms and both can explain each other, the instability segment fusion via anterior approach can obtain good therapeutic outcome.