Department of Orthopaedic Surgery, Rothman Institute/Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
Spine J. 2012 Aug;12(8):639-44. doi: 10.1016/j.spinee.2012.03.024. Epub 2012 May 5.
Dysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia.
To determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia.
Prospective cohort study.
Forty-three patients.
Validated dysphagia questionnaire, lateral cervical spine radiographs.
Patients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0-10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling.
Forty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling at any time point.
There is a significant increase in anterior cervical soft-tissue swelling after ACDF. The width of prevertebral soft-tissue does not correlate with postoperative dysphagia.
颈椎前路椎间盘切除融合术（ACDF）后早期常发生吞咽困难。多种机制，包括软组织肿胀，被认为是术后吞咽困难的原因。
确定术后吞咽困难患者的前软组织肿胀是否更大。
前瞻性队列研究。
43 例患者。
经过验证的吞咽困难问卷、颈椎侧位片。
纳入接受同种异体骨和前路器械进行单节段或双节段 ACDF 的患者。记录患者术前的人口统计学特征和病史。术前和术后 2 周和 6 周进行吞咽困难问卷，包括吞咽困难数字评分量表（DNRS；范围 0-10）。术前和术后 2 周和 6 周拍摄颈椎侧位片。测量每个节段的颈椎前软组织阴影宽度。根据术后 2 周吞咽困难问卷将患者分为两组：第 1 组（无症状/轻度吞咽困难）和第 2 组（中度/重度吞咽困难）。比较两组之间每个节段的前软组织阴影宽度。采用相关性分析评估 DNRS 与前软组织肿胀之间的关系。
纳入 43 例患者（24 例女性；平均年龄 47.9 岁）。15 例患者行单节段 ACDF，28 例患者行双节段 ACDF。除 C1 在 2 周和 6 周以及 C2 在 6 周外，所有节段的前软组织阴影宽度在 2 周和 6 周时均较术前显著增加。术后 2 周时，18 例患者无症状/轻度吞咽困难（第 1 组），25 例患者中度/重度吞咽困难（第 2 组）。第 1 组的平均 DNRS 为 1.1，第 2 组为 5.3（p<.001）。这种差异在 6 周时有所减小，但仍具有统计学意义。在任何节段，两组之间的软组织测量值均无显著差异。在任何时间点，DNRS 与前软组织肿胀均无显著相关性。
颈椎前路融合术后颈椎前软组织肿胀明显增加。椎体前软组织的宽度与术后吞咽困难无关。
