L'Institut de la Colonne Vertébrale, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago School of Medicine, Christchurch, New Zealand.
World Neurosurg. 2020 Jun;138:e305-e310. doi: 10.1016/j.wneu.2020.02.097. Epub 2020 Feb 25.
To assess the efficacy and safety of surgery for dysphagia in anterior cervical idiopathic hyperostosis.
This retrospective study included 11 consecutive patients presenting with dysphagia and anterior cervical idiopathic hyperostosis. Computed tomography scans and dynamic swallowing fluoroscopies were performed. The site of compression and the size and position of osteophytes were measured. The clinical outcomes and complications were recorded.
Two patients with anterior esophageal compression were found to have dysphagia caused by lower esophageal sphincter dysfunction. In the remaining 9 patients, the level of maximal compression was between C3 and C5 with the size of the osteophytes ranging from 8 to 17 mm. Intubation was challenging in 7 patients. Postoperative transient worsening of dysphagia was encountered in 3 patients. Two patients experienced severe complications including aphagia and respiratory compromise. Within 2 months of the operation, all patients reported satisfactory improvement of symptoms and a considerable gain in quality of life. No recurrence had occurred at final follow-up.
Anterior cervical hyperostosis causing dysphagia typically affects older men and results from compression between C3 and C5 from osteophytes of variable sizes. Operative intervention can provide long-lasting resolution of symptoms but is complicated by difficulty in endotracheal intubation, postoperative dysphagia, and rarely respiratory compromise. A systematic preoperative ear, nose, and throat consultation is recommended to reduce these complications.
评估手术治疗前颈特发性骨肥厚伴吞咽困难的疗效和安全性。
本回顾性研究纳入了 11 例因吞咽困难和前颈特发性骨肥厚就诊的患者。进行了计算机断层扫描和动态吞咽荧光检查。测量了压迫部位、骨赘的大小和位置。记录了临床结果和并发症。
2 例患者因食管下段括约肌功能障碍导致前食管受压，出现吞咽困难。在其余 9 例患者中，最大压迫水平位于 C3 至 C5 之间，骨赘大小为 8 至 17 毫米。7 例患者插管困难。3 例患者术后出现短暂吞咽困难加重。2 例患者出现严重并发症，包括吞咽困难和呼吸窘迫。术后 2 个月内，所有患者均报告症状明显改善，生活质量显著提高。最终随访时无复发。
前颈骨肥厚引起的吞咽困难通常影响老年男性，由 C3 至 C5 之间大小不一的骨赘压迫所致。手术干预可长期缓解症状，但存在气管插管困难、术后吞咽困难和罕见的呼吸窘迫等并发症。建议进行系统的耳鼻喉科术前咨询，以减少这些并发症。
