Kang Sung Shik, Lee Jung Sub, Shin Jong Ki, Lee Jae Myung, Youn Bu Hyun
Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Eur Spine J. 2014 Aug;23(8):1694-8. doi: 10.1007/s00586-014-3281-3. Epub 2014 Apr 3.
Little data are available regarding the influence of psychiatric factors on chronic dysphagia after anterior cervical spine surgery. The purpose of this study was to identify associations between psychiatric factors and the development of chronic dysphagia in patients after anterior cervical spine surgery.
The authors prospectively examined 72 patients with degenerative disc disease of the cervical spine who were treated by single-level anterior cervical discectomy and fusion. Demographic data including age, gender, body mass index, and smoking status were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Neck Disability Indices (NDI), and the Neck Pain and Disability Scale (NPDS) were assessed before surgery and at final follow-up. Psychiatric conditions were evaluated using the Zung depression scale and the Zung anxiety scale. At 1 year postoperatively, patients were contacted by telephone to determine the presence and severity of dysphagia. For statistical analyses, patients were divided into two groups: group I, those with No or Mild dysphagia; and group II, those with Moderate or Severe dysphagia at 1 year after surgery. Potential risk factors of chronic dysphagia were evaluated by multivariate logistic regression analysis.
The patients included 22 women and 50 men of overall average age 47.1 ± 7.8 years. The prevalences of No/Mild (group I) and Moderate/Severe (group II) dysphagia were 69.4% (50 patients) and 30.6% (22 patients), respectively. Mean preoperative NDI, NPDS, PCS, and MCS scores of 34.2, 44.8, 33.7, and 46.2 in the 72 study subject improved to 9.9, 16.1, 55.1, and 56.2, respectively, at 1 year after surgery. The mean preoperative ZDS and ZAS scores were 35.2 and 34.2, respectively. The two study groups were significantly different in terms of the presence of a psychiatric problem, preoperative NDIs, and MCS scores. However, multivariate logistic regression showed that the presence of a psychiatric problem prior to surgery (P = 0.005) was the only significant predictor of chronic dysphagia.
The presence of a psychiatric problem seems to be an important risk factor of chronic dysphagia in patients with cervical disc herniation. The study shows that psychiatric factors should be evaluated prior to surgery to determine the risk of chronic dysphagia.
关于精神因素对颈椎前路手术后慢性吞咽困难的影响，目前可用的数据较少。本研究的目的是确定精神因素与颈椎前路手术后患者慢性吞咽困难发生之间的关联。
作者前瞻性地检查了72例颈椎间盘退变疾病患者，这些患者接受了单节段颈椎前路椎间盘切除融合术。收集了包括年龄、性别、体重指数和吸烟状况在内的人口统计学数据。在手术前和最终随访时评估了简明健康状况调查量表36项、精神健康评分（MCS）、身体健康评分（PCS）、颈部功能障碍指数（NDI）以及颈部疼痛和功能障碍量表（NPDS）。使用zung抑郁量表和zung焦虑量表评估精神状况。术后1年，通过电话联系患者以确定吞咽困难的存在和严重程度。为了进行统计分析，将患者分为两组：第一组，无吞咽困难或轻度吞咽困难的患者；第二组，术后1年有中度或重度吞咽困难的患者。通过多因素logistic回归分析评估慢性吞咽困难的潜在危险因素。
患者包括22名女性和50名男性，总体平均年龄为47.1±7.8岁。无吞咽困难/轻度吞咽困难（第一组）和中度/重度吞咽困难（第二组）的患病率分别为69.4%（50例患者）和30.6%（22例患者）。72例研究对象术前NDI、NPDS、PCS和MCS的平均评分分别为34.2、44.8、33.7和46.2，术后1年分别改善至9.9、16.1、55.1和56.2。术前zung抑郁量表（ZDS）和zung焦虑量表（ZAS）的平均评分分别为35.2和34.2。两个研究组在精神问题的存在、术前NDI和MCS评分方面存在显著差异。然而，多因素logistic回归显示，术前存在精神问题（P = 0.005）是慢性吞咽困难的唯一显著预测因素。
精神问题的存在似乎是颈椎间盘突出症患者慢性吞咽困难的重要危险因素。该研究表明，术前应评估精神因素以确定慢性吞咽困难的风险。
