Garringer Sean M, Sasso Rick C
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46260, USA.
J Spinal Disord Tech. 2010 Oct;23(7):439-43. doi: 10.1097/BSD.0b013e3181bd0419.
Retrospective review of a prospectively collected database.
To determine the complications and safety of anterior cervical discectomy and fusion performed on an outpatient basis.
Anterior cervical discectomy and fusion performed as outpatient surgery is an appealing alternative and has many potential benefits. The safety of this practice, however, has not been thoroughly investigated. This study aims to examine the frequency of acute complications and rates of unplanned admissions for anterior cervical discectomy and fusions scheduled as outpatient procedures.
Data were collected prospectively on 645 consecutive patients undergoing anterior discectomy and fusion by a single surgeon for either stenosis or herniated nucleus pulposus involving 1 level. These data were then retrospectively reviewed for acute complications occurring within 48 hours of surgery. A subset consisting of the last 392 patients were further reviewed to better characterize this population. Complications after surgery as well as procedures requiring postoperative admission for any reason were detailed.
Two of 645 (0.3%) patients developed acute complications, both of which were epidural hematomas. Both occurred within the protocol's mandatory 4 hours postoperative observation time. Both resolved without permanent neurologic deficit. There were no retropharyngeal hematomas and no deaths. Six percent of patients required an unplanned admission. More than 80% of unplanned admissions were secondary to either pain or nausea.
One-level anterior cervical discectomy and fusion can be safely performed in an outpatient setting with a 4-hour observation period. There is a low rate (6%) of unplanned admission to the hospital. The number of unplanned admissions can be decreased by more than one-third if autogenous iliac crest bone graft is not harvested. The use of postoperative drains for 1-level anterior discectomy and fusion is called into question.
对前瞻性收集的数据库进行回顾性分析。
确定门诊进行颈椎前路椎间盘切除融合术的并发症及安全性。
门诊进行颈椎前路椎间盘切除融合术是一种有吸引力的选择，有许多潜在益处。然而，这种手术方式的安全性尚未得到充分研究。本研究旨在调查计划进行门诊手术的颈椎前路椎间盘切除融合术急性并发症的发生率及非计划入院率。
前瞻性收集了由一名外科医生连续进行的645例因狭窄或椎间盘突出症累及1个节段而接受前路椎间盘切除融合术患者的数据。然后对这些数据进行回顾性分析，以确定术后48小时内发生的急性并发症。对最后392例患者组成的亚组进行进一步分析，以更好地描述该人群特征。详细记录术后并发症以及因任何原因需要术后入院治疗的情况。
645例患者中有2例（0.3%）发生急性并发症，均为硬膜外血肿。均发生在方案规定的术后4小时强制观察期内。两者均在无永久性神经功能缺损的情况下得到缓解。无咽后血肿及死亡病例。6%的患者需要非计划入院。超过80%的非计划入院是由疼痛或恶心继发引起的。
单节段颈椎前路椎间盘切除融合术在门诊环境下进行4小时观察期是安全的。非计划入院率较低（6%）。如果不采用自体髂骨植骨，非计划入院人数可减少三分之一以上。单节段颈椎前路椎间盘切除融合术使用术后引流管的必要性受到质疑。
