Kolz Joshua M, Alvi Mohammed A, Bhatti Atiq R, Tomov Marko N, Bydon Mohamad, Sebastian Arjun S, Elder Benjamin D, Nassr Ahmad N, Fogelson Jeremy L, Currier Bradford L, Freedman Brett A
Department of Orthopedic Surgery, 4352Mayo Clinic, Rochester, MN, USA.
Department of Neurosurgery, 4352Mayo Clinic, Rochester, MN, USA.
Global Spine J. 2021 May;11(4):488-499. doi: 10.1177/2192568220912706. Epub 2020 Mar 20.
This was a retrospective cohort study.
When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia.
Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%).
Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, = .05) and had longer operative times (315 vs 121 minutes, = .01). Age of 75 years or less trended toward improvement in dysphagia ( = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication.
Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.
这是一项回顾性队列研究。
当颈椎前缘骨赘足够大时，可能会导致吞咽困难。目前关于颈椎前缘骨赘切除术治疗吞咽困难的疗效和并发症的研究较少。
通过回顾性研究确定了19例因吞咽困难诊断而接受颈椎前缘骨赘切除术的患者。平均年龄为71岁，随访时间为4.7年。手术最常见的节段是C3-C4（13例，69%）。
颈椎前缘骨赘切除术后，79%的患者吞咽困难得到改善。5例患者接受了颈椎融合术；未出现需要融合的延迟性或医源性不稳定情况。接受融合术的患者更年轻（64岁对71岁，P = 0.05），手术时间更长（315分钟对121分钟，P = 0.01）。75岁及以下的患者吞咽困难改善的趋势更明显（P = 0.09；OR = 18.8；95% CI 0.7 - 478.0），而严重吞咽困难患者并发症增加的趋势更明显（P = 0.07；OR = 11.3；95% CI = 0.8 - 158.5）。体重指数、是否有暴露手术医生、弥漫性特发性骨肥厚诊断、三个或更多节段手术、既往颈部手术以及融合术均不能预测改善情况或并发症。
颈椎前缘骨赘切除术可改善大多数有症状骨赘患者的吞咽功能。可增加脊柱融合术以解决狭窄和其他潜在的颈椎疾病，并有助于防止骨赘复发，而术中导航可用于确保完全切除骨赘而不穿透皮质或进入椎间盘间隙。由于并发症发生率相对较高，患者在手术前应接受全面的多学科检查及吞咽评估，以确认颈椎前缘骨赘是吞咽困难的主要原因。
