Clinical Features And Surgical Treatment Of The Coexistence Of Cervical Thoracic And Lumber Degenerative Disease

Objective:To study the clinical features and surgical treatment methods and strategies of the coexistence of cervical thoracic and lumbar degenerative disease.Methods:95 cases with cervical thoracic and lumbar degenerative disease at The Second Clinical Medical College of Shanxi Medical University, from January,2004 to December,2008 were retrospectively analyzed,with complete data.79 cases with surgical treatment.For the cervical spine,curvature decreases,straight and even anti-song,a larger posterior cervical osteophytes,cervical vertebra,health instability, limited spinal stenosis,with anterior surgery; developmental spinal stenosis,posterior longitudinalossification ligament (OPLL),ossification of yellow ligament hypertrophy or dorsal spinal cord compression, cervical spondylosis caused by multi-segment degeneration after anterior spinal stenosis or poor outcome,and cause unknown, line neck surgery;for many thoracic laminectomy by posterior decompression; the lumbar spine, according to prominence or pressure the size,location,whether there is ossification,select patients with posterior lumbar discectomy or posterior laminectomydecompression,fusion,internal fixation. According to preoperative,postoperative improvement of symptoms,JOA score improvement rate is employed to calculate and evaluate different surgical and curative effect of different operative strategies.Results:95 patients were followed up for 8 months to 68 months, an average of 38 months, using different surgical strategies, postoperative JOA score improved in varying degrees.79 underwent surgical treatment, among which 41 cases of simple cervical operation,improvement rate (66.06±14.33)%,5 routine thoracic surgery, improvement rate (56.19±9.85)%,12 routine lumbar spine surgery, improvement rate (63.49±9.78)%.21,paragraph 2 routine surgery,14 cases of operations on a line 2,to improve the rate (76.78±3.94)%,7 Legislation Sub two-line two-stage surgery,improvement rate (71.79±8.74)%.16 patients without surgical treatment,13 cases died with severe medical disease can not tolerate surgery,two cases of the operation was stopped due to economic reasons,one case didn't receive treatment due to higher risk of surgery, patient and his family's unwillingness.Conclusion:The coexistence of cervical thoracic and lumbar degenerative disease is a multiple segments,multi-performance complex disease mainly caused by the disc herniation and spinal stenosis.Attach importance to this disease is the premise of diagnosis,careful physical examination and the necessary diagnostic imaging is essential.The choice of surgical procedure may follow the principle of general surgery;for the master of the operation segments, the heavier stage of operation can be done first,both phases are heavier,the operation of two segments should be done;the further discussion of one and stage operation,stage operation is bound to delay the operation time,delay the recovery of neurological function,also have a certain relationship with the psychological enduring ability and economic conditions of patients,but the biggest drawback of one stage operation is large surgical trauma, some patients can not tolerate,and the ending of the operation require a higher treatment,the doctors are also required to have a skilled operative techniques.Therefore,treatment should be based on a multi-disciplinary judgement of symptoms and imaging performance of the patients and so on, choosing the best surgical program.