Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
University Centre of Surgery Intensive Care Unit, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
Eur Spine J. 2024 Oct;33(10):4012-4019. doi: 10.1007/s00586-024-08484-3. Epub 2024 Sep 6.
In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF.
We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen's definitions of complications and Clavien-Dindo's classification were used.
A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected.
PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.
在患有创伤性、感染性、退行性和肿瘤性颈椎外科适应证的患者中，通常采用前路方法。由于长时间机械通气，这些患者通常需要进行气管切开术。颈椎前路固定术（ACSF）的颈椎活动度有限且靠近手术部位，可能会增加经皮扩张气管切开术（PDT）的并发症风险。重要的是，PDT 可能会增加颈椎入路的伤口感染率。本研究旨在证明 ACSF 后 PDT 的安全性。
我们进行了一项回顾性、单中心研究，比较了接受和未接受 ACSF 并接受 Ciaglia 一步法 PDT 的患者。使用逻辑回归进行倾向评分匹配后，我们比较了术中及术后并发症发生率。此外，还评估了手术部位感染。并发症采用 Putensen 定义，分类采用 Clavien-Dindo 分级。
2009 年至 2021 年间，共有 1175 例患者接受了 PDT。57 例患者在 ACSF 后接受 PDT，并与 57 例无 ACSF 的患者进行匹配。ACSF 与 PDT 之间的平均间隔为 11.3 天。ACSF 组的总并发症发生率为 19.3%，非 ACSF 组为 21.1%。ACSF 组的平均随访时间为 388 天（±791），非 ACSF 组为 424 天（±819）。ACSF 患者中有 1.8%发生危及生命的并发症（Clavien-Dindo IV 至 V 级），非 ACSF 患者中有 3.5%发生。两组并发症发生率无显著差异。未发现 ACSF 前路入路的手术部位感染。
在 ACSF 后患者中，PDT 是一种可行且安全的方法。并发症发生率与无 ACSF 的患者相当。ACSF 的手术部位感染非常罕见。
