Lofrese Giorgio, Scerrati Alba, Balsano Massimo, Bassani Roberto, Cappuccio Michele, Cavallo Michele A, Cofano Fabio, Cultrera Francesco, De Iure Federico, Biase Francesco Di, Donati Roberto, Garbossa Diego, Menegatti Marta, Olivi Alessandro, Palandri Giorgio, Raco Antonino, Ricciardi Luca, Spena Giannantonio, Tosatto Luigino, Visani Jacopo, Visocchi Massimiliano, Zona Gianluigi, De Bonis Pasquale
Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy.
Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy.
Global Spine J. 2022 Oct;12(8):1751-1760. doi: 10.1177/2192568220988272. Epub 2021 Feb 16.
Retrospective multicenter.
diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH.
Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA.
24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( = 0.12) to the burr ( = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( = 0.15). Use of curved chisel reduced the surgical times ( = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( = 0.04) and shorter waiting times for surgery ( < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery.
The "age of DISH" counts more than patients' age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.
回顾性多中心研究。
累及颈椎的弥漫性特发性骨肥厚（DISH）是一种罕见疾病，可导致使人致残的气消化道症状。我们分析了术前准备和术中技术对接受DISH手术患者预后的影响。
收集需要进行颈椎前路骨赘切除术的DISH患者。吞咽研究和内镜检查辅助成像以确定骨减压的目标。记录患者特征、临床放射学表现、预后和手术策略。通过方差分析评估手术持续时间、手术时机和不同手术技术对临床预后的影响。
24例患者接受了手术。DISH累及的特定脊柱节段与术前吞咽困难的严重程度之间未发现相关性。使用凿子（P = 0.12）相较于使用磨钻（P = 0.65）有临床完全改善的趋势，并且无论骨肥厚是否累及该节段，只要C2 - C3节段进行减压（P = 0.15）。使用弯凿可缩短手术时间（P = 0.02），并与鼻胃管一起降低并发症风险，而涉及3个或更多节段的骨切除（P = 0.04）和较短的手术等待时间（P < 0.001）对吞咽完全恢复有积极影响。早期减压是首选，66.6%的患者在7天内症状消失。术后18 - 30个月的临床和影像学随访分别记录到1例和2例复发。
“DISH时代”比患者年龄更重要，即使术前吞咽困难较轻，减压的及时性对确定临床预后也至关重要。对于老年患者，针对性的骨切除可能是合理的，而对于年轻患者，更广泛的减压应更受青睐。
