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导致吞咽困难的颈椎前缘骨赘的手术治疗

Surgical treatment of anterior cervical osteophytes causing dysphagia.

作者信息

Ruetten Sebastian, Baraliakos Xenophon, Godolias Georgios, Komp Martin

机构信息

1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany.

2 Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Bochum, Germany.

出版信息

J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019837424. doi: 10.1177/2309499019837424.

Abstract

PURPOSE

Dysphagia due to anterior cervical osteophytes is a rare condition. However, it can become serious enough to permanently impair the quality of life up to making normal food intake impossible. If conservative treatment fails, there is the option of surgical resection of the osteophytes. The objective of this study was to assess the outcomes of resections of anterior cervical osteophytes causing spondylogenic dysphagia, taking literature into consideration.

METHOD

Resection of anterior cervical osteophytes using a standard anterior approach was performed in 14 consecutive patients with spondylogenic dysphagia between 2009 and 2015. Indomethacin or radiation was used to prevent recurrence. Imaging and clinical data were collected in follow-up examinations over an average of 50 months.

RESULTS

The osteophytes were sufficiently resected in all cases. Anterior plates were placed in three patients due to pronounced segmental mobility. Five patients were given recurrence prevention in the form of indomethacin, nine with radiation. One patient required revision surgery for a hematoma. No other serious complications were observed. All patients had significant improvement of their symptoms. No recurrences or signs of increasing instability were found during the follow-up period.

CONCLUSION

When conservative treatment fails, surgical resection of cervical osteophytes is a sufficient method for treating spondylogenic dysphagia. High patient satisfaction and improvement of the quality of life are achieved with a low complication rate. Routine additional stabilization has been discussed as recurrence prevention. Prophylaxis using indomethacin or radiation, known primarily from hip replacement, also appears to be an option.

摘要

目的

颈椎前缘骨赘导致的吞咽困难是一种罕见病症。然而,其可能严重到永久性损害生活质量,甚至无法正常进食。若保守治疗失败,可选择手术切除骨赘。本研究的目的是结合文献评估手术切除导致脊柱源性吞咽困难的颈椎前缘骨赘的疗效。

方法

2009年至2015年,对14例连续性脊柱源性吞咽困难患者采用标准前路入路切除颈椎前缘骨赘。使用吲哚美辛或放疗预防复发。在平均50个月的随访检查中收集影像学和临床数据。

结果

所有病例的骨赘均被充分切除。3例因节段性活动度明显而置入前路钢板。5例患者接受吲哚美辛预防复发,9例接受放疗。1例患者因血肿需要翻修手术。未观察到其他严重并发症。所有患者症状均有显著改善。随访期间未发现复发或不稳定加重迹象。

结论

当保守治疗失败时,手术切除颈椎骨赘是治疗脊柱源性吞咽困难的有效方法。该方法并发症发生率低,患者满意度高,生活质量得到改善。作为预防复发的措施,已讨论了常规附加稳定术。使用主要在髋关节置换中已知的吲哚美辛或放疗进行预防似乎也是一种选择。

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