Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
Spine (Phila Pa 1976). 2020 Apr 1;45(7):E379-E386. doi: 10.1097/BRS.0000000000003329.
Retrospective study.
To investigate the associated risk factors for acute respiratory distress after multilevel anterior cervical discectomy and fusion (ACDF) with a focus on the subjective symptom, dyspnea.
Acute respiratory distress after ACDF is a relatively common adverse event, the cause of which is usually soft tissue swelling or hematoma. It can result in serious morbidity and requires careful, focused treatment.
We reviewed the records of 532 patients (from January 2014 to August 2018) who had undergone multilevel ACDF surgery. Acute respiratory distress was defined as a complaint of dyspnea within 5 postoperative days. We investigated the patients' demographic parameters, comorbidities, and surgical procedure details. We also investigated radiologic parameters, including magnetic resonance imaging (MRI), with special attention to the prevertebral soft tissue thickness at C3 and C6. Statistical analysis was performed using the Student's t test and multiple logistic regression analysis.
Out of a total of 484 patients studied after exclusion criteria were applied, 31 patients (6.6%) experienced dyspnea after surgery. We selected 92 patients from the non-dyspnea group and compared them with 31 patients from the dyspnea group. On univariate analysis, upper cervical surgery involving C3, increased cord signal intensity on T2-weighted imaging (T2WI) magnetic resonance imaging (MRI), hypertension, smoking, and prevertebral soft tissue swelling at C3 level on postoperative day 1 were statistically significant factors associated with dyspnea. On logistic regression analysis, upper cervical surgery involving C3, increased cord signal intensity on T2WI MRI, and hypertension were found to be statistically significant variables (P < 0.05).
Patients undergoing upper cervical surgery involving C3, and having increased cord signal intensity on T2WI MRI and hypertension need to be monitored more carefully for acute respiratory distress after multilevel ACDF.
回顾性研究。
探讨颈椎前路多节段减压融合术（ACDF）后发生急性呼吸窘迫的相关危险因素，重点关注主观症状呼吸困难。
ACDF 后发生急性呼吸窘迫是一种较为常见的不良事件，其病因通常为软组织肿胀或血肿。它可能导致严重的发病率，并需要仔细、集中的治疗。
我们回顾了 2014 年 1 月至 2018 年 8 月期间接受颈椎前路多节段减压融合术的 532 例患者的记录。急性呼吸窘迫定义为术后 5 天内出现呼吸困难的主诉。我们调查了患者的人口统计学参数、合并症和手术过程细节。我们还研究了影像学参数，包括磁共振成像（MRI），特别注意 C3 和 C6 颈椎的椎前软组织厚度。使用学生 t 检验和多变量逻辑回归分析进行统计分析。
在应用排除标准后，共有 484 例患者进行了研究，其中 31 例（6.6%）术后出现呼吸困难。我们从无呼吸困难组中选择了 92 例患者，并与呼吸困难组的 31 例患者进行了比较。单因素分析显示，上颈椎手术累及 C3、T2 加权成像（T2WI）磁共振成像（MRI）上脊髓信号强度增加、高血压、吸烟和术后第 1 天 C3 水平的椎前软组织肿胀是与呼吸困难相关的统计学显著因素。在逻辑回归分析中，发现上颈椎手术累及 C3、T2WI MRI 上脊髓信号强度增加和高血压是统计学显著的变量（P<0.05）。
对于接受颈椎前路多节段减压融合术的患者，尤其是涉及 C3 的手术、T2WI MRI 上脊髓信号强度增加和高血压的患者，需要更密切地监测急性呼吸窘迫的发生。
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