Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Spine J. 2019 Apr;19(4):597-601. doi: 10.1016/j.spinee.2018.09.011. Epub 2018 Sep 21.
Carotid artery injury and stroke secondary to prolonged retraction remains an extremely rare complication in anterior cervical discectomy and fusion (ACDF). However, multiple studies have demonstrated that carotid artery retraction during the surgical approach may alter the normal blood flow, leading to a significant reduction in the cross-sectional area of the vessel. Others have suggested that dislodgment of atherosclerotic plaques following manipulation of the carotid artery can be a potential risk for intracranial embolus and stroke.
We aimed to evaluate: (1) the incidence of postoperative stroke following ACDF and (2) incidence of other postoperative complications in a cohort of patients who had a diagnosis of carotid artery stenosis (CAS) versus those who did not.
This study utilized the Statewide Planning and Research Cooperative System database from January 1, 2009 to December 31, 2013. All patients who underwent (ACDF) and had a preoperative diagnosis of CAS were identified using the International Classification of Disease, ninth revision codes. Those who had a previous history of stroke were excluded. Patients who had CAS were propensity score matched to patients without history of CAS for demographics and Charlson/Deyo comorbidity scores.
Incidence of postoperative stroke and other complications were compared between the cohorts. The threshold for statistical significance was set at a p<.05. This study received no funding. The authors report no conflict of interests relevant to this study.
There were 34,975 patients who underwent an ACDF in the study time period. After excluding those under the age of 18 and with history of previous stroke, there were 61 patients who had CAS that were compared with a propensity-matched cohort. The CAS cohort had a significantly higher incidence of postoperative stroke during their hospitalization (6.6% vs 0%, p<.042). The CAS cohort also had higher rates of acute renal failure (27.9% vs 4.9%, p = .01) and sepsis (18% vs 4.9%, p = .023). There were no stroke related deaths.
Patients with CAS who underwent ACDF had a statistically significant greater incidence of developing a postoperative stroke. To the best of our knowledge, no previous study has evaluated the development of postoperative stroke in patients with CAS undergoing ACDF. Larger, multicenter studies are needed to estimate the true incidence of stroke in this specific patient population. However, our results may illustrate the importance of preoperative optimization, approach-selection, and postoperative stroke surveillance in patients with a history of CAS who undergoes ACDF.
在颈椎前路椎间盘切除融合术（ACDF）中，颈动脉损伤和由此导致的中风是一种极其罕见的并发症。然而，多项研究表明，在手术过程中对颈动脉的牵拉可能会改变正常的血流，导致血管横截面积显著减小。其他人则认为，颈动脉操作后动脉粥样硬化斑块的脱落可能是颅内栓子和中风的潜在风险。
我们旨在评估：（1）在 ACDF 后发生术后中风的发生率；（2）在一组诊断为颈动脉狭窄（CAS）的患者和未诊断为 CAS 的患者中，其他术后并发症的发生率。
本研究利用 2009 年 1 月 1 日至 2013 年 12 月 31 日期间全州规划与研究合作系统数据库。使用国际疾病分类，第九版代码识别所有接受 ACDF 且术前诊断为 CAS 的患者。排除有中风既往史的患者。对有 CAS 病史的患者进行倾向评分匹配，以匹配无 CAS 病史的患者的人口统计学和 Charlson/Deyo 合并症评分。
比较两个队列之间术后中风和其他并发症的发生率。统计显著性阈值设定为 p<.05。本研究没有获得资金。作者报告与本研究无关的利益冲突。
在研究期间，有 34975 名患者接受了 ACDF。排除年龄在 18 岁以下和有中风既往史的患者后，有 61 名患者患有 CAS，并与倾向匹配的队列进行了比较。CAS 组在住院期间中风的发生率明显更高（6.6%比 0%，p<.042）。CAS 组还具有更高的急性肾功能衰竭发生率（27.9%比 4.9%，p =.01）和脓毒症发生率（18%比 4.9%，p =.023）。没有与中风相关的死亡。
接受 ACDF 的 CAS 患者术后中风的发生率有统计学意义的增加。据我们所知，以前没有研究评估过在接受 ACDF 的 CAS 患者中发生术后中风的情况。需要更大规模的多中心研究来估计该特定患者人群中风的真实发生率。然而，我们的结果可能说明了在接受 ACDF 的 CAS 患者中，术前优化、入路选择和术后中风监测的重要性。
