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颈椎前路手术与吞咽困难。

Anterior cervical spine surgery and dysphagia.

机构信息

Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center.

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Curr Opin Otolaryngol Head Neck Surg. 2022 Dec 1;30(6):417-421. doi: 10.1097/MOO.0000000000000845. Epub 2022 Aug 10.

Abstract

PURPOSE OF REVIEW

The purpose of this review is to summarize current evidence regarding dysphagia in anterior cervical spine surgeries (ACSS) and to present recent advances in evaluation and surgical technique.

RECENT FINDINGS

Various risk factors for dysphagia have been identified, and they include female sex, smoking history, prior surgery and cervical lordotic angle. EAT-10 is a validated tool for the assessment of individuals with dysphagia post-ACSS. Local intraoperative corticosteroid application significantly reduced the incidence and magnitude of dysphagia in four out of five studies that were reviewed. Individuals who had undergone cervical disc replacement (CDR) and revision surgery by a zero-profile anchored spacer (ROI-C) device experienced less dysphagia than those who had anterior cervical discectomy with fusion (ACDF). Videofluoroscopic swallow study (VFSS) after ACSS demonstrated pharyngeal weakness and increased posterior pharyngeal wall thickness, while no other abnormality was found.

SUMMARY

Different technique variations can reduce dysphagia severity in individuals undergoing ACSS. Surgeons are encouraged to continue performing randomized control studies to assist in choosing the most favourable technique for the patient.

摘要

目的综述

本文旨在总结颈椎前路手术(ACSS)后吞咽困难的现有证据,并介绍评估和手术技术的最新进展。

最近的发现

已经确定了各种与吞咽困难相关的风险因素,包括女性、吸烟史、既往手术史和颈椎前凸角。EAT-10 是评估 ACSS 后吞咽困难患者的有效工具。五项研究中有四项显示,局部术中皮质类固醇的应用显著降低了吞咽困难的发生率和严重程度。接受颈椎间盘置换术(CDR)和零切迹锚定间隔器(ROI-C)修复手术的患者吞咽困难的发生率低于接受前路颈椎间盘切除术和融合术(ACDF)的患者。ACSS 后的荧光透视吞咽研究(VFSS)显示咽肌无力和后咽壁厚度增加,但未发现其他异常。

总结

不同的技术变化可以减轻行 ACSS 患者的吞咽困难严重程度。鼓励外科医生继续进行随机对照研究,以帮助为患者选择最有利的技术。

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