Subluxacion cervical espondiloartrosica / Degenerative cervical subluxation

ABSTRACT

Objective: To analyze the biomechanical and anatomical factors and the surgical treatment and outcome in cervical degenerative spondylolisthesis. Method: Between 1978 and 2003, 223 patients underwent surgery for cervical spondylotic myelopathy, 41 patients presented with degenerative subaxial subluxation. According to the Nurick scale, 26 were grade 2, 14 were grade 3 and 1 was grade 4. Those with degenerative subluxation were older compared to those who had only spondylotic myelopathy (63 vs 13 years). The former also corresponded to higher grades of the Nurick scale. All patients underwent static and dynamic plain radiographs, and MRI. We found 29 subluxations of one level, 11 patients with affection of two levels and 1 with three levels. 33 patients had unstable subluxations. The most commonly affected levels were C3-C4 and C4-C5. In all the cases, an anterior approach with autogenous bone graft and locking plate was performed. REsults: After surgical teatment, 21 grade 2 patients improved one grade, while 5 improved two grades; 9 grade 3 patients improved one grade and 1 two grades; the grade 4 patient improved one grade. Conclusion: Cervical degenerative subluxation is seen in older patients, usually associated with severe myelopathy and spondylotic changes. The cervical instability is more common in the C3-C4 and C4-C5 segments. In all the cases of our group there was a loss of cervical lordosis or kyphosis with ankylosis of the lower cervical spine. The anterior approach with autogenous bone graft and locking plate, allowed spinal cor decompression and cervical fusion