Jenkins Nathaniel W, Parrish James M, Nolte Michael T, Jadczak Caroline N, Mohan Shruthi, Geoghegan Cara E, Hrynewycz Nadia M, Podnar Jeffrey, Buvanendran Asokumar, Singh Kern
Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois.
Department of Anesthesiology, Midwest Anesthesia Partners LLC, Park Ridge, Illinois.
Int J Spine Surg. 2021 Apr;15(2):219-227. doi: 10.14444/8030. Epub 2021 Apr 1.
Patient selection and analgesic techniques, such as the multimodal analgesic (MMA) protocol, aid in ambulatory surgical center (ASC) cervical spine surgery. The purpose of this case series is to characterize patients undergoing anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (CDR) in an ASC with an enhanced MMA protocol.
A prospectively maintained registry was retrospectively reviewed for cervical surgeries between May 2013 and August 2019. Inclusion criteria included ASC patients who underwent single-level or multilevel CDR or ACDF using an MMA protocol. Baseline, intraoperative, and postoperative characteristics were recorded, including length of stay, visual analog scale pain scores, neck disability index, complications, and narcotics administered.
A total of 178 patients met inclusion criteria with 125 single-level, 52 two-level, and 1 three-level procedure. Of those patients, 127 underwent ACDF and 51 underwent CDR. The longest procedure was 95 minutes and the mean length of stay was 6.1 hours, with 2 patients requiring hospital admission. All other patients were discharged within 10 hours. One of the admitted patients experienced a postoperative seizure that was later determined to be secondary to drug use and serotonin syndrome. The second patient developed an anterior cervical hematoma 5 hours postoperatively, which was immediately evacuated. The patient was admitted for observation and discharged the next day.
In our study, patients experienced considerable improvement in disability scores, with a low likelihood of postoperative complications. A safe and effective MMA protocol may help facilitate anterior cervical surgery in the outpatient setting.
Transitioning anterior cervical discectomy and fusions to the ASC requires an appropriate MMA protocol. Our findings reveal that an enhanced MMA protocol will help improve disability scores while keeping the likelihood of postoperative complications low. This supports the ASC setting for cervical spine procedures in appropriate patient populations.
患者选择和镇痛技术，如多模式镇痛（MMA）方案，有助于门诊手术中心（ASC）的颈椎手术。本病例系列的目的是描述在采用强化MMA方案的ASC中接受颈椎前路椎间盘切除融合术（ACDF）和全颈椎间盘置换术（CDR）的患者特征。
对2013年5月至2019年8月期间颈椎手术的前瞻性维护登记册进行回顾性审查。纳入标准包括使用MMA方案接受单节段或多节段CDR或ACDF的ASC患者。记录基线、术中及术后特征，包括住院时间、视觉模拟量表疼痛评分、颈部功能障碍指数、并发症及使用的麻醉药品。
共有178例患者符合纳入标准，其中125例为单节段手术，52例为双节段手术，1例为三节段手术。这些患者中，127例行ACDF，51例行CDR。最长手术时间为95分钟，平均住院时间为6.1小时，2例患者需要住院。所有其他患者均在10小时内出院。其中1例入院患者术后发生癫痫，后来确定是由药物使用和血清素综合征引起的。第二例患者术后5小时出现颈椎前路血肿，立即进行了清除。该患者入院观察，次日出院。
在我们的研究中，患者的功能障碍评分有显著改善，术后并发症的可能性较低。安全有效的MMA方案可能有助于在门诊环境中开展颈椎前路手术。
3级。
将颈椎前路椎间盘切除融合术过渡到ASC需要适当的MMA方案。我们的研究结果表明，强化MMA方案将有助于改善功能障碍评分，同时保持术后并发症的可能性较低。这支持了在合适的患者群体中在ASC进行颈椎手术。
