Fountas Kostas N, Kapsalaki Eftychia Z, Nikolakakos Leonidas G, Smisson Hugh F, Johnston Kim W, Grigorian Arthur A, Lee Gregory P, Robinson Joe S
Department of Neurosurgery, Medical Center of Central Georgia, Mercer University, School of Medicine, Macon, GA, USA.
Spine (Phila Pa 1976). 2007 Oct 1;32(21):2310-7. doi: 10.1097/BRS.0b013e318154c57e.
Retrospective review study with literature review.
The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management.
It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable.
In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months.
The mortality rate in our current series was 0.1% (1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3% (196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5% of our patients. Postoperative hematoma occurred in 5.6%, but required surgical intervention in only 2.4% of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1% of our cases. Dural penetration occurred in 0.5%, esophageal perforation in 0.3%, worsening of preexisting myelopathy in 0.2%, Horner's syndrome in 0.1%, instrumentation backout in 0.1%, and superficial wound infection in 0.1% of our cases.
Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.
回顾性研究并进行文献综述。
我们当前研究的目标是提高对颈椎前路椎间盘切除融合术（ACDF）相关并发症及其早期检测和妥善处理的认识。
已知ACDF是最常施行的脊柱手术之一。在大多数情况下，其结果相当令人满意。然而，偶尔出现的并发症可能会变得棘手，在极少数情况下甚至是灾难性的。尽管有几例病例报告描述了此类并发症，但它们的发生率通常报告不足，并且缺乏关于其在大型临床系列中确切发生率的数据。对ACDF潜在的术中和术后相关并发症有细致的了解至关重要，以便尽可能避免这些并发症，并在不可避免时成功且安全地进行处理。
在一项回顾性研究中，对1015例因退行性椎间盘疾病和/或颈椎病导致神经根病和/或脊髓病而首次接受ACDF的患者进行了评估。我们所有患者均采用标准的史密斯-罗宾逊入路，同时使用自体或同种异体移植物，有或没有使用钢板。查阅手术报告、医院和门诊病历以及影像学研究，以查找与手术相关的并发症。平均随访时间为26.4个月。
我们当前系列中的死亡率为0.1%（1015例患者中的1例，死亡继发于食管穿孔）。我们的总体发病率为19.3%（1015例患者中的196例）。最常见的并发症是单纯术后吞咽困难，在我们9.5%的患者中观察到。术后血肿发生率为5.6%，但仅2.4%的病例需要手术干预。有症状的喉返神经麻痹在我们3.1%的病例中出现。硬脊膜穿破发生率为0.5%，食管穿孔为0.3%，原有脊髓病加重为0.2%，霍纳综合征为0.1%，内固定松动为0.1%，浅表伤口感染为0.1%。
对ACDF相关并发症的细致了解有助于对其进行妥善处理。术后吞咽困难、血肿和喉返神经麻痹是我们系列中最常见的并发症。在我们大多数病例中，并发症的处理是成功的。
