颈椎邻近节段病变的研究进展及预防措施

Research progress and preventive measures of cervical adjacent segment pathology

颈椎前路椎间盘切除减压融合术(ACDF)是治疗颈椎病最常用的手术方式,尽管该手术在临床已取得显著成效,但术后每年约3%的患者出现邻近节段的退行性改变,多数邻近节段病变(ASP)的发生不可避免,且发病原因复杂多样。人工颈椎间盘置换术(CDR)可以更好地保留颈椎的自身活动度,相比融合手术可以减缓或避免ASP的发生。现有研究证实,手术方式及术者操作对ASP的发生有着重要影响,非融合代替融合治疗方案、恢复颈椎矢状面曲度以及合理选择手术节段可以有效预防ASP的发生。

Anterior cervical discectomy and fusion(ACDF)is the most popular surgical method for the treatment of cervical disease.Although ACDF has achieved remarkable results in clinical practice,about 3%of patients have degenerative changes of adjacent segments each year.Most of the adjacent segment pathology(ASP)is inevitable,and the causes are complex and diverse.Cervical disc replacement can retain the motion of the cervical spine better and slow down or avoid the occurrence of ASP compared with fusion surgery.Present studies have confirmed that the operation mode and operator's operation are associated with the occurrence of ASP.Some measures like using non fusion treatment instead of fusion,restoration of cervical sagittal plane and reasonable selection of surgical segment can effectively prevent the occurrence of ASP.