颈椎前路椎间盘切除融合术后四年新发吞咽困难：病例报告及文献综述
The new onset of dysphagia four years after anterior cervical discectomy and fusion: Case report and literature review.
作者信息
Ansari Darius, Burley Halle E K, von Glinski Alexander, Elia Christopher, Chapman Jens R, Oskouian Rod J
机构信息
Seattle Science Foundation, Seattle, Washington.
Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois.
出版信息
Surg Neurol Int. 2020 Feb 28;11:32. doi: 10.25259/SNI_46_2020. eCollection 2020.
BACKGROUND
Dysphagia is a common complication immediately following anterior cervical spine surgery. However, its onset more than 1-year postoperatively is rare.
CASE DESCRIPTION
A 45-year-old male initially underwent a C3-4 and C5-6 anterior cervical discectomy and fusion (ACDF). At age 49, 4 years later, he presented with worsening dysphagia accompanied by neck and right upper extremity pain. Radiographs demonstrated an extruded left C3 screw, which had migrated into the prevertebral soft tissues at the C4-C5 level; there was also loosening of the right C3 screw. The subsequent barium swallow study revealed that the screw was embedded in the pharyngeal wall. The patient required a two-stage operation; first, to remove the anterior instrumentation, and second, to perform a posterior instrumented C2-T2 fusion.
CONCLUSION
A barium swallow study and other dynamic imaging are a valuable component of the diagnostic workup and therapeutic intervention to evaluate the delayed onset dysphagia following an ACDF.
背景
吞咽困难是颈椎前路手术后常见的并发症。然而，术后1年以上出现吞咽困难的情况较为罕见。
病例描述
一名45岁男性最初接受了C3-4和C5-6颈椎前路椎间盘切除融合术（ACDF）。4年后，49岁时，他出现吞咽困难加重，并伴有颈部和右上肢疼痛。X线片显示一枚C3左侧螺钉脱出，移位至C4-C5水平的椎前软组织；右侧C3螺钉也有松动。随后的吞钡造影研究显示螺钉嵌入咽壁。患者需要进行两阶段手术；首先，取出前路内固定器械，其次，进行后路C2-T2内固定融合术。
结论
吞钡造影研究和其他动态成像检查是评估ACDF术后迟发性吞咽困难的诊断检查和治疗干预的重要组成部分。
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