Gendreau Julian L, Sheaffer Kristin, Bennett Josiah, Abraham Mickey, Patel Nitesh V, Herschman Yehuda, Ruh Nikki, Lindley James G
Eisenhower Army Medical Center, Fort Gordon.
Mercer University School of Medicine, Savannah, GA.
Clin Spine Surg. 2021 Jul 1;34(6):220-227. doi: 10.1097/BSD.0000000000001105.
This was a systematic review and meta-analysis.
The objective was (1) to measure rates of successful resolution of dysphagia in patients after undergoing surgical intervention for diffuse idiopathic skeletal hyperostosis (DISH); and (2) to determine if older age, longer duration of preoperative symptoms, or increased severity of disease was correlated with unsuccessful surgical intervention.
DISH, also known as Forestier disease, is an enthesopathy affecting up to 35% of the elderly population. Many patients develop osteophytes of the anterior cervical spine, which contribute to chronic symptoms of dysphagia causing debilitating weight loss and possibly resulting in the placement of a permanent gastrostomy feeding tube. For patients that fail conservative medical management, an increase in surgical interventions have been reported in the literature in the last 2 decades.
A systematic search was performed on PubMed, Medline, Cochrane Library, and Embase. Studies measuring outcomes after surgical intervention for patients with dysphagia from DISH were selected for inclusion. Two independent reviewers screened and assessed all literature in accordance with Cochrane systematic reviewing standards.
In total, 22 studies reporting 119 patients were selected for inclusion. Successful relief of dysphagia was obtained in 89% of patients after surgical intervention. Failure to relieve dysphagia was associated with increased length of symptoms preoperatively (P<0.01) using logistic regression. Patients with more severe preoperative symptoms also seem to have an increased risk for treatment failure (risk ratio, 2.86; 95% confidence interval, 1.19-6.85; P=0.02). Treatment failure was not associated with patient age, use of intraoperative tracheostomy, implementation of additional fusion procedures, level of involved segments, or number of involved segments.
Patients undergoing surgical intervention have a higher likelihood of failing surgery with increasing preoperative symptom length and increased preoperative symptom severity.
Level III.
这是一项系统评价和荟萃分析。
目的是（1）测量弥漫性特发性骨肥厚（DISH）患者接受手术干预后吞咽困难成功缓解的发生率；（2）确定年龄较大、术前症状持续时间较长或疾病严重程度增加是否与手术干预失败相关。
DISH，也称为Forestier病，是一种附着点病，影响高达35%的老年人群。许多患者会出现颈椎前路骨赘，这会导致吞咽困难的慢性症状，导致体重减轻，甚至可能需要放置永久性胃造口喂养管。对于保守药物治疗无效的患者，过去20年的文献报道手术干预有所增加。
在PubMed、Medline、Cochrane图书馆和Embase上进行了系统检索。选择测量DISH吞咽困难患者手术干预后结局的研究纳入。两名独立评审员根据Cochrane系统评价标准筛选和评估所有文献。
总共选择了22项报告119例患者的研究纳入。手术干预后89%的患者吞咽困难得到成功缓解。使用逻辑回归分析，术前症状持续时间延长与吞咽困难未缓解相关（P<0.01）。术前症状较严重的患者治疗失败风险似乎也增加（风险比，2.86；95%置信区间，1.19-6.85；P=0.02）。治疗失败与患者年龄、术中气管切开术的使用、额外融合手术的实施、受累节段水平或受累节段数量无关。
术前症状持续时间延长和术前症状严重程度增加，接受手术干预的患者手术失败的可能性更高。
三级。
