单节段前路颈椎间盘切除融合术后吞咽困难的预测因素。
Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion.
机构信息
Hospital for Special Surgery, New York, New York.
Midwest Orthopedics at Rush, Chicago, IL.
出版信息
Spine (Phila Pa 1976). 2019 Apr 1;44(7):E400-E407. doi: 10.1097/BRS.0000000000002865.
STUDY DESIGN
Retrospective review of prospectively collected data.
OBJECTIVE
To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF).
SUMMARY OF BACKGROUND DATA
Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy.
METHODS
Dysphagia was assessed by swallowing quality of life (SWAL-QOL) scores preoperatively, at 6 weeks and 12 weeks. Patient reported outcome measures (PROMs) including visual analog scale (VAS) and Neck Disability Index (NDI) were collected preoperatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable.
RESULTS
Sixty-four patients were included, 41 received a zero profile device, and 23 received plate-graft construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs. 54.43 ± 14.71 min, P = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed preoperative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs. 3.43 ± 3.21, P = 0.007).
CONCLUSION
Operative time and preoperative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard.
LEVEL OF EVIDENCE
研究设计
前瞻性数据回顾。
目的
研究零切迹装置在单节段颈椎前路椎间盘切除融合术（ACDF）中吞咽困难发生率方面是否优于传统的板/笼结构。
背景资料概要
ACDF 后吞咽困难的发生率高达 83%，大多数病例是自限性的，但在多达 35%的患者中，慢性吞咽困难仍会持续存在。零切迹装置的开发是为了限制吞咽困难和其他与板相关的并发症，但目前文献对其疗效存在分歧。
方法
术前、术后 6 周和 12 周通过吞咽生活质量（SWAL-QOL）评分评估吞咽困难。术前、术后 6 周和术后 6 个月收集患者报告的结果测量（PROMs），包括视觉模拟评分（VAS）和颈部残疾指数（NDI）。以 SWAL-QOL 评分为因变量进行单变量和多变量回归分析。
结果
共纳入 64 例患者，其中 41 例接受零切迹装置治疗，23 例接受板-笼构建治疗。两组患者的人口统计学特征相似，除手术时间外，零切迹组的手术时间短于笼板组（44.88±6.54 与 54.43±14.71 分钟，P=0.001）。在所有时间点，两组的吞咽困难发生率相似。回归分析证实，术前 SWAL-QOL 和手术时间是唯一有显著意义的变量。除术后 6 个月的 VAS 颈痛外，两组在所有时间点的 PROMs 也相似，板-笼组的 VAS 颈痛评分较低（1.05±1.48 与 3.43±3.21，P=0.007）。
结论
手术时间和术前 SWAL-QOL 评分是单节段 ACDF 吞咽困难的预测因素。零切迹装置的手术时间显著缩短，在这方面可能有助于降低吞咽困难的发生率。
证据等级
3。
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