Zabat Michelle A, Mottole Nicole A, Patel Hershil, Norris Zoe A, Ashayeri Kimberly, Sissman Ethan, Balouch Eaman, Maglaras Constance, Protopsaltis Themistocles S, Buckland Aaron J, Roberts Timothy, Fischer Charla R
Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
J Clin Neurosci. 2022 May;99:44-48. doi: 10.1016/j.jocn.2022.02.024. Epub 2022 Feb 28.
Abundant literature exists describing the incidence of dysphagia following anterior cervical surgery; however, there is a paucity of literature detailing the incidence of dysphagia following posterior cervical procedures. Further characterization of this complication is important for guiding clinical prevention and management. Patients ≥ 18 years of age underwent posterior cervical fusion with laminectomy or laminoplasty between C1-T1. Pre- and post-operative dysphagia was assessed by a speech language pathologist. The patient cohort was categorized by approach: Laminectomy + Fusion (LF) and Laminoplasty (LP). Patients were excluded from radiographic analyses if they did not have both baseline and follow-up imaging. The study included 147 LF and 47 LP cases. There were no differences in baseline demographics. There were three patients with new-onset dysphagia in the LF group (1.5% incidence) and no new cases in the LP group (p = 1.000). LF patients had significantly higher rates of post-op complications (27.9% LF vs. 8.5% LP, p = 0.005) but not intra-op complications (6.1% LF vs. 2.1% LP, p = 0.456). Radiographic analysis of the entire cohort showed no significant changes in cervical lordosis, cSVA, or T1 slope. Both group comparisons showed no differences in incidence of dysphagia pre and post operatively. Based on this study, the likelihood of developing dysphagia after LF or LP are similarly low with a new onset dysphagia rate of 1.5%.
有大量文献描述了颈椎前路手术后吞咽困难的发生率;然而,详细阐述颈椎后路手术后吞咽困难发生率的文献却很少。对这种并发症进行进一步的特征描述对于指导临床预防和管理很重要。年龄≥18岁的患者接受了C1-T1节段的颈椎后路融合术并同时进行了椎板切除术或椎板成形术。术前和术后的吞咽困难由言语病理学家进行评估。患者队列按手术方式分类:椎板切除术+融合术(LF)和椎板成形术(LP)。如果患者没有基线和随访影像学资料,则排除在影像学分析之外。该研究包括147例LF病例和47例LP病例。基线人口统计学特征无差异。LF组有3例新发吞咽困难患者(发生率1.5%),LP组无新发病例(p = 1.000)。LF患者术后并发症发生率显著更高(LF组为27.9%,LP组为8.5%,p = 0.005),但术中并发症发生率无差异(LF组为6.1%,LP组为2.1%,p = 0.456)。对整个队列的影像学分析显示颈椎前凸、颈椎矢状面垂直轴(cSVA)或T1斜率无显著变化。两组比较显示术前和术后吞咽困难发生率无差异。基于这项研究,LF或LP术后发生吞咽困难的可能性同样较低新发吞咽困难率为1.5%。