Lui Jonathan Y C, Sayal P, Prezerakos G, Russo V, Choi D, Casey A T H
University College London, London, United Kingdom.
Dept. of Neurosurgery, The National Hospital for Neurology & Neurosurgery, London, United Kingdom.
Clin Neurol Neurosurg. 2018 Apr;167:36-42. doi: 10.1016/j.clineuro.2018.02.010. Epub 2018 Feb 7.
This study reviews the management pathway and surgical outcomes of patients referred to and operated on at a tertiary neurosurgical centre, for dysphagia associated with anterolateral cervical hyperostosis (ACH) in diffuse idiopathic skeletal hyperostosis (DISH).
PATIENTS & METHODS: Electronic patient records for 6 patients who had undergone anterior cervical osteophytectomy for dysphagia secondary to ACH were reviewed. ACH diagnosis was made by an Ear, Nose and Throat (ENT) specialist and patients were referred to a neurosurgical-led multidisciplinary team (MDT) for review. A senior radiologist performed imaging measurements and vertebral level localization was confirmed via barium-swallow video-fluoroscopy. Speech and language therapists (SLTs) determined the suitability of pre-operative conservative management. Patients were followed-up post-operatively with clinical and radiological assessments.
6 patients (Male to female ratio, 6:0; mean age, 59 years) were referred to a tertiary neurosurgical centre with DISH related dysphagia, an average of 25 months after ENT review (range, 14-36 months) between 2005 and 2016. The vertebral levels implicated in dysphagia ranged from C2 to T1 with a median of 4 vertebral levels involved. The most frequently affected vertebral levels were C4-6 (all 6 patients). The average antero-posterior height (as measured on axial images) of the most prominent osteophyte was 15.9 mm (range 12.0-20.0 mm). Patients underwent elective cervical osteophytectomy on average 10.8 months after neurosurgical review (range, 3-36 months). One patient had a post-operative haematoma needing evacuation and prolonged hospital stay. The average duration of follow-up was 42.3 months. All our patients maintained good symptomatic resolution without osteophyte recurrence.
All our patients experienced significant and sustained clinical improvement. Anterior cervical osteophytectomy consistently leads to improvement in symptomatic ACH patients without recurrence. Early referral to a neurosurgical multi-disciplinary team (MDT) is indicated in ACH related dysphagia, once conservative management has failed.
本研究回顾了在一家三级神经外科中心就诊并接受手术的弥漫性特发性骨肥厚（DISH）患者中，与前外侧颈椎骨质增生（ACH）相关吞咽困难的管理途径和手术结果。
回顾了6例因ACH继发吞咽困难而接受前路颈椎骨赘切除术的患者的电子病历。ACH诊断由耳鼻喉科（ENT）专家做出，患者被转介至以神经外科为主导的多学科团队（MDT）进行评估。一名资深放射科医生进行影像学测量，并通过吞钡视频透视确认椎体水平定位。言语和语言治疗师（SLT）确定术前保守治疗的适用性。术后对患者进行临床和影像学评估随访。
2005年至2016年间，6例（男女比例为6:0；平均年龄59岁）与DISH相关吞咽困难的患者被转介至三级神经外科中心，在ENT评估后平均25个月（范围14 - 36个月）。与吞咽困难相关的椎体水平范围为C2至T1，平均累及4个椎体水平。最常受累的椎体水平是C4 - 6（所有6例患者）。最突出骨赘的平均前后径（在轴位图像上测量）为15.9毫米（范围12.0 - 20.0毫米）。患者在神经外科评估后平均10.8个月（范围3 - 36个月）接受了选择性颈椎骨赘切除术。1例患者术后出现血肿，需要进行引流并延长住院时间。平均随访时间为42.3个月。我们所有患者的症状均得到良好缓解，且无骨赘复发。
我们所有患者均经历了显著且持续的临床改善。前路颈椎骨赘切除术能持续改善有症状的ACH患者，且无复发。一旦保守治疗失败，对于ACH相关吞咽困难，建议尽早转介至神经外科多学科团队（MDT）。
