Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-0081, Japan.
Department of Orthopaedic Surgery, Yaizu City Hospital, 1000 Doubara, Yaizu-city, Shizuoka, 425-0055, Japan.
J Orthop Surg Res. 2023 Jun 28;18(1):467. doi: 10.1186/s13018-023-03937-9.
Anterior cervical spine surgery to C2 (ACSS-C2) is a challenging procedure that often results in postoperative persistent dysphagia or dyspnea due to injury to the internal branch of the superior laryngeal nerve (iSLN) or the relatively narrow and soft oropharynx. This study aimed to describe the surgical outcomes of our modified approach with temporary infrahyoid muscle detachment during ACSS-C2.
Patients who underwent ACSS-C2 at two institutions between June 2015 and January 2022 were prospectively enrolled. Intraoperatively, we performed temporary detachment of the infrahyoid muscle from the hyoid bone to improve laryngeal mobility and accessibility to C2. This procedure also allowed for the easy identification and preservation of the iSLN. We retrospectively investigated the surgery-related complications and outcomes of bony fusion.
Twelve patients were enrolled in this study; five and seven patients underwent single- and multi-level fusion surgery, respectively. Intraoperative preservation of the iSLN and proper visualization of C2 were achieved in all cases. Subsequent decompression and instrumentation were successfully performed. Two older patients (78 and 81 years) who underwent multi-level fusion experienced transient postoperative dysphagia. None of the patients required unplanned reintubation or revision surgery because of instrumentation failure. Solid bony fusion was achieved in all cases.
Our modified approach with temporary infrahyoid muscle detachment during ACSS-C2 reduces the incidence of postoperative persistent dysphagia and dyspnea. However, in older patients at high risk for postoperative dysphagia, multi-level fusion should be avoided, and alternative procedures should be considered.
颈椎前路手术至 C2（ACSS-C2）是一项具有挑战性的手术，由于喉上神经内支（iSLN）或相对狭窄和柔软的咽腔损伤，常导致术后持续性吞咽困难或呼吸困难。本研究旨在描述我们在 ACSS-C2 期间采用暂时性舌骨下肌分离的改良方法的手术结果。
在 2015 年 6 月至 2022 年 1 月期间，两个机构前瞻性地招募了接受 ACSS-C2 的患者。术中，我们进行了暂时性的舌骨下肌从舌骨上的分离，以改善喉的活动性并更容易触及 C2。该过程还可以轻松识别和保护 iSLN。我们回顾性调查了与手术相关的并发症和骨融合的结果。
本研究共纳入 12 例患者，其中 5 例和 7 例分别接受了单节段和多节段融合手术。所有病例均在术中成功保留 iSLN，并正确显示 C2。随后进行了有效的减压和器械固定。2 例年龄较大的患者（78 和 81 岁）接受了多节段融合，术后出现短暂性吞咽困难。没有患者因器械失败而需要计划外重新插管或再次手术。所有病例均获得了坚固的骨性融合。
我们在 ACSS-C2 期间采用暂时性舌骨下肌分离的改良方法，降低了术后持续性吞咽困难和呼吸困难的发生率。然而，对于有术后吞咽困难高风险的老年患者，应避免多节段融合，而应考虑替代手术方案。
