Objective To evaluate the outcome and surgical indications of combined posterior and anterior approach for severe degenerative cervical diseases.Methods 17 patients with severe degenerative cervical diseases were operated by combined posterior and anterior approach.The procedures were posterior open-door laminoplasty and decompression followed ,after 6 months or one-stage,by anterior approach together with anterior fusion and internal fixation.Results No one died of the operation and deteriorated of neurological function.The complications included 2 cerebrospinal fluid leakage and 2 axial symptoms.13 patients were followed up for 6～42 months.The average JOA score improved from (8.3 ± 2.28) of pre-operation to (13.1 ± 1.27) of post-operation.There were significant difference between preoperative and postoperative scores (t = 11.5 ,P＜0.01 ), with the recovery rate of 66.5 ％.Conclusion Surgical treatment of one-stage combined posterior and anterior approach can provide a satisfactory result.This technique has the features of sufficient decompression,lower risk of spinal cord injury compared with single anterior approach and lower incidence of nerve root palsy compared with single posterior approach.It is indicated for patients with multi-level involvement and severe compression in front of the spinal cord and with good general condition.%目的 探讨后前路联合手术治疗严重颈椎退行性疾病的疗效和手术适应证.方法 施行后前路联合手术治疗严重颈椎退行性疾病17例,其中男11例,女6例;年龄46～72岁,平均56.3岁.3例分期后前路手术,14例一期后前路手术.手术步骤为先行后路单开门椎管扩大成形术,然后一期或分期(6个月后)行前路椎管前方减压、植骨融合内固定术.结果 无围手术期死亡及神经功能加重病例,术后发生脑脊液漏2例,轴性疼痛2例.术后随访13例,JOA评分由术前平均(8.3±2.28)分增至术后平均(13.1±1.27)分,手术前后评分差异显著(t-11.5,P<0.01),脊髓功能改善率为66.5%.结论 一期后前路联合手术疗效满意.该手术方式减压充分,可降低单纯前路手术脊髓损伤的风险和减少单纯后路手术后C<,5>神经根麻痹的发生率,适用于全身情况较好、多节段颈椎病变伴脊髓前方局部受压严重的患者.
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