| Abstract: |
Lower cervical instability is a common and serious problem which may develop due to traumatic , neoplastic, infectious or degenerative conditionsWe reviewed the subject of treatment of lower cervical instability due to degenerative condition by anterior interbody fusion: regarding anatomy of this region, biomechanics of vertebral body , disc , facet joint , spinous processes , ligaments and muscles, also elements of stability and range of motion .We also reviewed pathology of degenerative disc changes with their 4 stages, the clinical picture regarding neck pain , radiculopathy and myelopathy , the radiological investigations : plain x ray, M R I, Myelography, C.T., discography, E M G discussing the value of each one.We reviewed the surgical management of this problem by anterior discectomy and interbody fusion.Regarding the clinical part of this study , the work was a prospective study of 30 case (12 males – 18 females) with mean age of 30 years suffering from degenerative lower cervical instability managed by anterior interbody fusion by cage (24 cases) or plate with graft (6 cases).All patients were subjected to history taking, examination, investigation and surgical managementThe neurological conditions were assessed (22 cases presented with radiculopathy) 8 cases presented with radiculomylopathy) with mean duration of complaint of 21 months.The most common level affected was: C 5-6 (46.7%) 14 cases, C 4-5 (26.7%) 8 cases, C 3-4 (16.7%) 5 cases, and C 6-7 (10%) 3 cases.Neck pain index , prolo scdre of radiculupathy and JOA were assessed in every patient pre and post operative and showed marked improvement in all cases in a mean follow up period of 14.4months. Our results are not markedly different from the results of other series.Finally we recommend the use of antertior cervical decompression and interbody fusion in cases with degeneratine disc disease associated with radiculopathy not responding to conservative management for 3 months or myelopathy just appeared.The results is related primarily to the degree and the time of neural compression, adequate neural decompression, the maintenance of vertebral alignment and the meticulous operative steps regardless the implant employed.
|
|
|