Samtani Rahul G, Huttman Daniel, Weinreb Jeffrey H, Cyriac Matthew, Yu Warren, O'Brien Joseph R
University of Wisconsin Hospitals and Clinics, Department of Orthopedic Surgery and Rehabilitation, Madison, Wisconsin.
Department of Orthopaedic Surgery, George Washington University, Washington, DC.
Int J Spine Surg. 2021 Aug;15(4):676-682. doi: 10.14444/8089. Epub 2021 Jul 15.
The anterior approach to the cervical spine is associated with postoperative dysphagia. It is difficult to predict which patients are most at risk for dysphagia. The objective of this study was to determine if placing an esophageal temperature probe preoperatively would affect the severity and length of postoperative dysphagia. We hypothesize that use of an esophageal temperature probe would result in worse postoperative dysphagia at all measured time points as measured by the Swallowing-Quality of Life (SQAL-QOL) survey after anterior cervical discectomy and fusion (ACDF).
A total of 44 patients were enrolled in a prospective, randomized controlled trial and randomized into groups: 1 with an esophageal temperature probe placed at the time of surgery and 2 without. A total of 39 patients filled out postoperative SWAL-QOL questionnaires at their preoperatives. Using the survey results, the data were analyzed between groups and subanalyzed based on number of operative levels and sex.
SWAL-QOL scores for patients undergoing 2-level ACDF with an esophageal temperature probe were significantly better compared with those without a probe at 2 weeks and 6 months postoperatively. These results were not significant at other time points in in the overall analysis, but a trend toward improved dysphagia scores at each time point postoperatively was seen with the probe group. No differences were found between the 2 groups with respect to age at the time of surgery, sex, and preoperative SWAL-QOL score.
Placement of an esophageal temperature probe at the time of surgery significantly improved postoperative dysphagia scores in patients undergoing 2-level ACDF at 2 weeks and 6 months postoperatively.
2 CLINICAL RELEVANCE: Placement of a temperature probe is a safe and effective technique that is readily available and easily applicable to the practice of spine surgery and may improve postoperative dysphagia after ACDF.
颈椎前路手术与术后吞咽困难相关。很难预测哪些患者发生吞咽困难的风险最高。本研究的目的是确定术前放置食管温度探头是否会影响术后吞咽困难的严重程度和持续时间。我们假设,在前路颈椎间盘切除融合术(ACDF)后,通过吞咽生活质量(SQAL-QOL)调查测量,使用食管温度探头会导致在所有测量时间点的术后吞咽困难更严重。
共有44例患者纳入一项前瞻性随机对照试验,并随机分为两组:1组在手术时放置食管温度探头,2组未放置。共有39例患者在术前填写了术后SWAL-QOL问卷。利用调查结果,对两组数据进行分析,并根据手术节段数量和性别进行亚分析。
在术后2周和6个月时,接受两级ACDF并使用食管温度探头的患者的SWAL-QOL评分明显优于未使用探头的患者。在总体分析的其他时间点,这些结果并不显著,但探头组在术后每个时间点均有吞咽困难评分改善的趋势。两组在手术时的年龄、性别和术前SWAL-QOL评分方面均未发现差异。
手术时放置食管温度探头可显著改善接受两级ACDF的患者在术后2周和6个月时的吞咽困难评分。
2 临床相关性:放置温度探头是一种安全有效的技术,容易获得且易于应用于脊柱外科手术,可能改善ACDF后的术后吞咽困难。