Ghobrial George M, Harrop James S, Sasso Rick C, Tannoury Chadi A, Tannoury Tony, Smith Zachary A, Hsu Wellington K, Arnold Paul M, Fehlings Michael G, Mroz Thomas E, De Giacomo Anthony F, Jobse Bruce C, Rahman Ra'Kerry K, Thompson Sara E, Riew K Daniel
Thomas Jefferson University, Philadelphia, PA, USA.
Indiana University, Indianapolis, IN, USA.
Global Spine J. 2017 Apr;7(1 Suppl):12S-16S. doi: 10.1177/2192568216687546. Epub 2017 Apr 1.
Retrospective multi-institutional case series.
The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.
A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections.
A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities.
The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series.
回顾性多机构病例系列研究。
颈椎前路椎间盘切除融合术（ACDF）为外科医生提供了治疗多种颈椎病变的灵活性，其中大多数用于退行性和创伤性适应症。文献中关于术后手术部位感染的表现和真实发生率的数据有限。
进行了一项回顾性多中心病例系列研究，涉及北美脊柱学会临床研究网络的21个高容量手术中心，这些中心因其在脊柱护理、临床研究基础设施和经验方面的卓越表现而被选中。回顾了2005年1月1日至2011年12月31日（含）期间接受颈椎手术（C2至C7节段）的17625例患者的病历，以确定21种预先定义的治疗并发症的发生情况。在数据库中识别接受ACDF的患者，并对术后颈椎前路感染的发生情况进行回顾。
通过对提供术后颈椎前路感染数据的21个中心进行回顾性数据库分析，共识别出8887例患者（21个中心中的17个，回复率81%）。ACDF术后共识别出6例感染，平均发生率为0.07%（范围为0%至0.39%）。所识别患者的平均年龄为57.5岁（标准差=11.6，66.7%为女性）。平均体重指数为22.02。在所有感染患者中，一半是吸烟者（n=3）。2例患者出现脊髓病，3例患者出现神经根型症状。平均住院时间为4.7天。所有患者均接受了积极的手术治疗以处理该并发症，所有患者均有改善。无死亡病例。
ACDF术后感染的发生率极低。以往的处理方法是紧急冲洗和清创手术部位。然而，由于这种情况罕见，管理指南仅限于回顾性系列研究。
