Surgical treatment of degenerative cervical instability
- VernacularTitle:退行性颈椎不稳的手术治疗
- Author:
Jianyuan JIANG
;
Xin MA
;
Jun XIA
- Publication Type:Journal Article
- Keywords:
Cervical vertebrae;
Joint instability;
Spinal fusion
- From:
Chinese Journal of Orthopaedics
1996;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective Cervical instability was mostly caused by trauma. However, degenerative cervical instability was diagnosed rarely according to the present criteria although cervical degeneration was common in aged people. The study was aimed at investigating the results of surgical treatment for degenerative cervical instability and to define the indications for surgical intervention. Methods From April 1998 to April 2001, anterior cervical fusion and plate fixation were applied in fifteen patients, there were 6 males and 9 females aged from 44 to 65 years with an average of 55.2 years. The patients showed roentgenographic instability of the cervical spine associating with cervical postural symptoms. Spondylotic cervical myelopathy were excluded from the group. The cervical postural symptoms were those presented or aggravated with flexion-extension or rotational movements of the cervical spine, such as neck-shoulder pain, cervical spondylotic radiculopathy symptoms, sympathetic or vertebral artery symptoms. The symptoms lasted from 18 months to 4 years before the index surgery, all patients had received more than one year conservative treatments, but no any improvement. Seven cases were fused with iliac autograft, in which three cases were on single intervertebral spaces, four cases on double spaces, and grooved bone graft was used in the patient of double space fusion. Intervertebral fusion cage (Titanium mesh) was used in 8 cases; allograft was used in 2 single space cases; grooved autograft was used in 6 double space cases. Excised vertebral body was used as autograft material. Results The patients were followed up from 8 months to 4 years with an average of 25 months. All patients were satisfactory for the surgical results in follow-up period. All symptoms were released in 12 cases, occasional neck pain was found in 3 cases, and there was no abnormality presented in clinical examination. Solid fusion was achieved in all of cases at follow-up, the fused segment was stable judging by dynamic roentgenogram. Conclusion Fusion of the unstable segments is an alternative procedure for degenerative cervical instability in case the cervical postural symptoms are consistent with the radiographic features. Since some degenerative instability of cervical spine may spontaneously achieve re-stabilization, the indication of surgical fusion must be strictly limited to avoid over-treatment.
