Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review

Background contextVocal cord palsy (VCP) is a known complication of anterior cervical spine surgery. However, the true incidence and interventions to minimize this complication are not well studied.PurposeTo conduct a systematic review to identify the incidence, risk, and interventions for VCP after anterior cervical spine surgery.Study designThis is a qualitative systematic literature review.SampleProspective and retrospective trials of patients undergoing anterior cervical spine surgery that reported on postoperative VCP or recurrent laryngeal nerve palsy.Outcome measuresPrimary: incidence of VCP after anterior cervical spine surgery; secondary: risk factors and interventions for prevention of VCP after anterior cervical spine surgery.MethodsElectronic searches were conducted on Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews for clinical studies reporting VCP in anterior cervical spine surgery, limited to studies published between 1995 and June 2013 in English and French languages. After selection of studies independently by two review authors, data on incidence, risk, and interventions were extracted. Qualitative analysis was performed on three domains: quality of studies, strength of evidence, and impact of interventions.ResultsOur search has identified 187 abstracts, and 34 studies met our inclusion criteria. The incidence of VCP ranges from 2.3% to 24.2%. Significant heterogeneity in study design and definition of VCP were used in the published studies. There is good evidence that reoperation increases the risk of VCP. One study of moderate strength suggests that operating from the right side may increase the risk of VCP. Among the interventions studied, endotracheal tube (ETT) cuff pressure monitoring with deflation during retraction has shown to reduce the incidence from 6% to 2%, but this result was not confirmed by randomized control trials. Limited evidence exists for other interventions of intraoperative electromyographic monitoring and methylprednisolone.ConclusionsVocal cord palsy is a significant morbidity after anterior cervical surgery with incidence up to 24.2% in the immediate postoperative period, with a higher risk in reoperation of the anterior cervical spine. Moderate evidence exists for ETT cuff pressure adjustment in preventing this complication.     

A comparative study for the usage of Fidji cervical cages after multilevel anterior cervical discectomy and fusion

BackgroundPostoperative dysphagia is one major concern in the treatment for patients with cervical spine spondylosis by using anterior cervical discectomy and fusion (ACDF) with plating and cage system.PurposeTo evaluate the influence of two types of surgery for multilevel cervical spondylotic myelopathy (CSM) on postoperative dysphagia, namely ACDF with cage alone (ACDF-CA) using Fidji cervical cages and ACDF with cage and plate fixation (ACDF-CP).MethodsA retrospective study was performed in 62 consecutive patients with multilevel CSM, including 32 underwent ACDF-CA (group A) and 30 underwent ACDF-CP (group B). All enrolled patients were followed up at 48 h, 2 months and 6 months postoperatively, when the dysphagia rate, Swallowing-Quality of Life (SWAL-QOL) score and the thickness of prevertebral soft tissue were recorded.ResultsAt 48 h and 2 months, the dysphagia rate and thickness of prevertebral soft tissue were both significantly lower in group A than in group B, while the SWAL-QOL score of group A was significantly higher than that of group B. No significant difference was observed at 6 months.ConclusionFidji cervical cages could relieve postoperative dysphagia in the treatment of multilevel CSM with ACDF, especially at the first several months postoperatively.     

颈椎前路手术后吞咽困难的原因分析

目的：探讨颈椎前路手术后发生吞咽困难的相关因素。方法：随访2002年10月～2004年10月间颈椎前路手术患者490例。其巾男306例，女184例；年龄12～76岁，平均47．2岁；诊断为颈椎病415例，颈椎骨折脱位43例．颈椎间盘突出症22例，颈椎椎体肿瘤8例．颈椎结核2例。观察患者手术后是否存在吞咽困难；对于存在吞咽困难的患者均静脉应用地塞米松及对症治疗。结果：共有96例（19．6％）患者出现不同程度吞咽困难，持续时间3周～24个月。男42例，女54例，年龄38～63岁，平均57．6岁。96例吞咽困难患者巾，使用钛板内同定89例．使用颈椎椎间融合器7例：颈椎融合术未加内固定者及颈椎人工间盘置换者均未出现吞咽困难病例。女性、高龄及使用钛板内植物等因素与吞咽困难之间存在相关性。96例患者平均随访14．2个月，90例（93．7％）吞咽困难的症状消失或减轻，6例（6.3％）症状无改善。结论：吞咽困难是颈椎前路手术后常见的并发症；其发生可能与多种因素有关。临床医生应给予相应重视和采取相应措施以减少其发生。     

Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors

Background

Dysphagia is a common complication of anterior cervical spine surgery, and most of them occurred in the early postoperative period. This study aimed to determine the incidence of early dysphagia after anterior cervical spine surgery and to identify its risk factors.

Methods

A review of 186 consecutive patients undergoing anterior cervical spine surgeries in a 3-year period was performed. Dysphagia at postoperative 1 month was surveyed, and the severity of dysphagia was evaluated. Demographic information and procedural characters were collected to determine their relationships to dysphagia.

Results

A total of 50 patients developed early postoperative dysphagia, including 23 males and 27 females. The incidence of early dysphagia after anterior cervical spine surgery was 26.9 % in this study. Mild, moderate, and severe dysphagia were found in 30, 14, and 6 patients, respectively. Female, advanced age, multi-levels surgery, use of plate, and a big protrusion of plate were found to be significantly increased early dysphagia after anterior cervical spine surgery.

Conclusion

There is a relatively high incidence of early dysphagia after anterior cervical spine surgery, which may be attributable to multiple factors.     

Vertebral artery injury in cervical spine surgery: anatomical considerations,management, and preventive measures

Background contextVertebral artery (VA) injury can be a catastrophic iatrogenic complication of cervical spine surgery. Although the incidence is rare, it has serious consequences including fistulas, pseudoaneurysm, cerebral ischemia, and death. It is therefore imperative to be familiar with the anatomy and the instrumentation techniques when performing anterior or posterior cervical spine surgeries.PurposeTo provide a review of VA injury during common anterior and posterior cervical spine procedures with an evaluation of the surgical anatomy, management, and prevention of this injury.Study designComprehensive literature review.MethodsA systematic review of Medline for articles related to VA injury in cervical spine surgery was conducted up to and including journal articles published in 2007. The literature was then reviewed and summarized.ResultsOverall, the risk of VA injury during cervical spine surgery is low. In anterior cervical procedures, lateral dissection puts the VA at the most risk, so sound anatomical knowledge and constant reference to the midline are mandatory during dissection. With the development and rise in popularity of posterior cervical stabilization and instrumentation, recognition of the dangers of posterior drilling and insertion of transarticular screws and pedicle screws is important. Anomalous vertebral anatomy increases the risk of injury and preoperative magnetic resonance imaging and/or computed tomography (CT) scans should be carefully reviewed. When the VA is injured, steps should be taken to control local bleeding. Permanent occlusion or ligation should only be attempted if it is known that the contralateral VA is capable of providing adequate collateral circulation. With the advent of endovascular repair, this treatment option can be considered when a VA injury is encountered.ConclusionsVA injury during cervical spine surgery is a rare but serious complication. It can be prevented by careful review of preoperative imaging studies, having a sound anatomical knowledge and paying attention to surgical landmarks intraoperatively. When a VA injury occurs, prompt recognition and management are important.     

气管推移训练对颈椎前路减压植骨融合内固定术术后康复影响的研究

目的 探讨术前气管推移训练对颈椎前路减压植骨融合内固定术的患者术后并发症及术后康复的影响。方法 回顾性分析江门市中心医院2017年1月到2021年7月行颈椎前路减压植骨融合内固定术的患者205例的临床资料,其中行单节段颈椎前路减压植骨融合内固定术的患者122例,行双节段颈椎前路减压植骨融合内固定术的患者83例。单节段患者中62例为术前气管推移训练组,60例为对照组。双节段患者中45例为气管推移训练组,38例为对照组。观察和分析的指标包括术后饮水呛咳、声音嘶哑、咽喉疼痛时间、咽喉疼痛程度、术后声音嘶哑及术后吞咽困难。结果 205例患者全部顺利完成手术,无患者死亡。在单节段颈椎前路减压植骨融合内固定术的患者中,气管推移训练组和对照组在术后饮水呛咳、术后声音嘶哑、术后吞咽困难等方面的差异无统计学意义（P>0.05）,但气管推移训练组比对照组术后咽喉疼痛的时间更短,术后咽喉疼痛的程度更轻（P<0.05）。在双节段颈椎前路减压植骨融合内固定术的患者中,气管推移训练组比对照组发生术后饮水呛咳、声音嘶哑、吞咽困难的患者更少（P<0.05）,术后咽喉疼痛的时间更短、程度更轻（P<0.05）。结论 颈椎前路减压植骨融合内固定术的患者术前进行气管推移训练有利于患者术后的术后快速康复,增强患者的术后舒适感,尤其对双节段颈椎前路减压植骨融合内固定术的患者更加明显。     

椎前软组织肿胀和颈椎前路融合术后吞咽困难的相关性研究

目的 探讨颈椎前路融合术后椎前软组织肿胀和吞咽困难是否存在相关性。方法 随访研究自2009-01-2011-01接受颈椎前路融合术的患者73例,按照Bazaz-Yoo吞咽困难评分方法分为正常组（无/轻症状组,n=38）和吞咽困难组（中/重症状组,n=35）,参照Penning法测量颈椎侧位X线片上术前、术后软组织宽度,分析2组椎前软组织宽度变化值（即椎前软组织肿胀程度）。结果 2组间术前椎前软组织宽度比较,差异无统计学意义（P〉0.05）,2组间术前-术后椎前软组织宽度变化值有显著差异,吞咽困难组明显高于正常组,差异有统计学意义（P〈0.05）。结论 颈椎前路融合术后椎前软组织肿胀和吞咽困难的发生具有正相关性,推测椎前软组织肿胀可能是吞咽困难发生的机制之一。椎前软组织肿胀（程度）作为预测颈椎前路融合术后吞咽困难发生率的有效指标,具有一定的临床指导意义。     

Zero‐Profile Implant System for Treatment of Dysphagia Caused by Noncontiguous Anterior Cervical Osteophytes—A Case Report with Literature Review

BackgroundEsophageal cervical spondylosis is a rare type of cervical spondylosis which causes dysphagia. Surgical osteophyte resection is taken when conservative treatment does not respond. However, few reports on its operation and postoperative follow‐up. We first present a case showing how the Zero‐Profile implant system is utilized to treat dysphagia caused by noncontiguous anterior cervical osteophytes.Case PresentationA patient with progressive dysphagia was referred to our department. Imaging examinations revealed a large diffuse idiopathic skeletal hyperostosis (DISH) related anterior osteophyte in C3/4, C6/7 and ossification of the anterior and posterior longitudinal ligaments. Anterior cervical osteophytectomy, discectomy, and fusion were performed on C3/4, C6/7. Two Zero‐Profile implants were implanted. Postoperative dysphagia was significantly improved, and the patient was free to swallow large pills or solid foods at nine‐years follow‐up.ConclusionOsteophyte excision can effectively treat esophageal cervical spondylosis, This case shows that fusion using the Zero‐Profile implant system is a viable option for patients with potential cervical instability following osteophyte resection.     

Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study

Anterior cervical discectomy and fusion is commonly performed for cervical disc disease. Most studies report that swallowing and voice problems after such surgeries tend to resolve with time and are often of minor significance except in the rare cases of recurrent laryngeal nerve palsies. A retrospective review was performed on patients who had anterior cervical discectomy and fusion by a single surgeon more than 5 years prior, to determine the persistence of swallowing and voice problems in them.Seventy-four patients who had anterior cervical discectomy and fusion with allograft and plating an average of 7.2 years prior responded to an invitation to return for a follow-up clinical review. Emphasis was placed on the symptoms of dysphagia and dysphonia, as related to the index surgery. At final review, persistent dysphagia was present in 26 patients (35.1%). This occurred more frequently in females and in younger patients. Dysphonia at final review persisted in 14 patients (18.9%). This also occurred more commonly in females and in patients in whom possible non-union is present in at least one of the levels operated upon. Problems with singing were present in 16 patients (21.6%) postoperatively, occurring more frequently if the C3/4 disc was included in the surgery and in patients who have had a greater total number of anterior cervical surgeries at the time of review. Dysphonia and dysphagia are persistent problems in a significant proportion of patients, even beyond 5 years after anterior cervical spine surgery.The study was performed at the Columbia Spine Centre, Columbia, Missouri, USAPresented at the Cervical Spine Research Society (European Section) Annual Meeting, Porto, Portugal, 30 May to 5 June 2004     

Risk factors for postoperative dysphagia and dysphonia following anterior cervical spine surgery: a comprehensive study utilizing the hospital for special surgery dysphagia and dysphonia inventory (HSS-DDI)

BACKGROUND CONTEXTPostoperative dysphagia and dysphonia (PDD) are prevalent complications after anterior cervical discectomy and fusion (ACDF). Identification of risk factors for these complications is necessary for effective prevention. Recently, patient reported outcome measures (PROM) have been used to determine PDD after ACDF. The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) is a validated PROM that specifically assesses dysphagia and dysphonia after anterior cervical spine surgery.PURPOSETo identify the perioperative risk factors for PDD utilizing the HSS-DDI.STUDY DESIGN/SETTINGObservational study of prospectively collected data at a single academic institution.PATIENT SAMPLEPatients undergoing anterior cervical discectomy and fusion from 2015 to 2019 who enrolled in the prospective data collection.OUTCOME MEASUREThe HSS-DDI administered 4 weeks, 8 weeks, and 4-6 months after surgery.METHODSAs potential risk factors, the data on demographic factors, analgesic medications, history of psychiatric illness, preoperative sagittal alignment, surgical factors, preoperative diagnoses, and preoperative Neck Disability Index (NDI) scores were collected. Bivariate and multivariable regression analyses utilizing the Tobit model were conducted.RESULTS291 patients were included in the final analysis. The median HSS-DDI at 4-weeks, 8 weeks, and 4-6 months postoperatively, were 80.7, 92.7, and 98.4, respectively. Multivariable analysis demonstrated that current smoking, previous cervical spine surgery, preoperative C2-7 angle, upper level surgery, multilevel surgery, opioid use, and a high preoperative NDI score, were independent contributing factors to a low HSS-DDI score at 4-weeks follow-up. Intraoperative topical steroid use was an independent protective factor for a low HSS-DDI score. Opioid use and high NDI score remained independent factors at 4-6 months. Sub-domain analysis demonstrated that prior cervical surgery, preoperative C2-7 angle, multilevel surgery, and intraoperative topical steroid use were significant for dysphagia only. Current smoking was significant for dysphonia only.CONCLUSIONSOur results showed that preoperative opioid use and a high preoperative NDI score are novel independent risk factors for postoperative dysphagia and dysphonia in addition to other known factors.     

Clinical Efficacy Analysis of the New PRUNUS Spine Plate System for Anterior Cervical Spine Surgery

Objective

Although the role of anterior cervical titanium plate system in stabilizing the spine sequence and promoting bone graft fusion has been widely recognized, more and more attention has been paid to the design of the plate itself and the complications caused by it. In order to solve the problems of poor stability of internal fixation, plate displacement and screw looseness, we designed the new PRUNUS spine plate system. Hence, the present study was conducted to describe observe and evaluate the clinical efficacy of a new type of three-leaf reinforced cervical anterior screw plate system (PRUNUS nailing system) developed for anterior cervical surgery.

Methods

A retrospective analysis of 56 patients from June 2018 to October 2019 was used. Twenty-seven patients with cervical spine disease treated with new PRUNUS nail plate internal fixation were selected as the observation group, and 29 patients with cervical spine disease treated with conventional cervical anterior screw fixation were selected as the control group. Postoperative follow-up was performed. Cervical stability, internal fixation position and bone graft fusion were evaluated according to imaging data. The operative time, intraoperative blood loss, cervical Cobb angle, pain visual analogue scale (VAS), and Japanese orthopaedic association (JOA) were compared between the two groups. Spinal function scores and neurological improvement rates were used to evaluate the clinical efficacy of the new PRUNUS spine plate.

Results

The patients were followed up for 5–18 months, with an average of 7.33 months. The average operative time of the observation group was 98.4 ± 9.2 min, and the mean intraoperative blood loss was 65.3 ± 10.6 ml, which were significant different from the control group's 109.7 ± 9.4 minutes (P < 0.05), 72.9 ± 15.6 ml (P < 0.05). Comparison between the two groups in postoperative and final follow-up of cervical Cobb angle, JOA score and improvement rate, VAS score and preoperative comparison showed no significant differences (P > 0.05).

Conclusion

The new PRUNUS spine plate system can be applied to the anterior cervical spine surgery, and its clinical efficacy was similar to the traditional cervical anterior plate. But PRUNUS simplified the operation process, especially suitable for the surgical treatment of anterior cervical revision and osteoporosis patients.     

Brown-Sequard-type myelopathy due to cervical disc herniation associated with severe carotid stenosis prompting rapid combined corpectomy and carotid endarterectomy under deep anticoagulant therapy

Background contextThe risk of stroke because of carotid retraction during an anterior cervical spine surgery as well as the risk of bleeding complications after an anterior cervical corpectomy under deep anticoagulation and antiplatelet therapy is a surgical issue poorly addressed in the literature.PurposeTo describe the feasibility and safety of a simultaneous carotid endarterectomy and anterior corpectomy and fusion under deep anticoagulation in a patient with a cervical spinal cord compression and a severe carotid artery stenosis.Study designCase report.MethodsThe authors describe the case of a 79-year-old man who had a 1-month history of progressive pain in the neck and left arm, associated with progressive weakness in the left arm and leg. He also presented a history of coronaropathy and bilateral severe carotid stenosis for which he was receiving a regimen of antiplatelet therapy.ResultsThe cervical magnetic resonance imaging demonstrated a C4–C5 disc herniation migrating down to C5. His condition worsened rapidly during hospitalization prompting a rapid decompression. Given the necessity of a C5 corpectomy and the risk of stroke during anterior cervical spine surgery, it was therefore decided to undertake the surgical procedure under efficient anticoagulant and antiplatelet therapy. A combined endarterectomy and spinal decompression and fusion were then performed. The postoperative course was uneventful, and the patient recovered neurologically.ConclusionsThis case suggests that such a combined carotid endarterectomy and cervical corpectomy with fusion under anticoagulant and antiplatelet therapy is feasible. However, even if the unique clinical presentation of our patient led us to undertake such a surgical strategy, therapeutic decision in patients presenting with both severe carotid stenosis and cervical spinal cord compression should rely on a case-by-case analysis.     

Vertebral artery (V2) pseudo-aneurysm after surgery for cervical schwannoma. How to prevent it and a review of the literature

Study designCase report and review of the literature.ObjectiveTo prevent and manage a suspected iatrogenic vertebral artery injury during a cervical spine anterior approach.Summary of background dataThe anterior spine approach is a common surgery with few complications. One of the rare but significant risks is vertebral artery injury. Consequences of vertebral artery injuries are often delayed. Therefore, it is essential to prevent this complication and to know how when exploring after a suspected vertebral artery injury.MethodsReport of a case and review of the literature. A 61-year-old woman presented with a cervical schwannoma involving the C5–C6 foramen. She had undergone surgery 22 years before by the posterior approach. We performed an anterior cervical approach. After 12 days, a vertebral artery pseudo-aneurysm occurred. Our review of the literature is focalized on vertebral artery injuries during cervical surgery by the anterior approach.ResultsThe patient was treated by coil embolization with a good outcome. To our knowledge, only 6 cases of vertebral artery pseudo-aneurysm after surgery have been reported in the literature.ConclusionAccording to the literature, vertebral artery pseudo-aneurysms resulting in anterior cervical approach are rare but their consequences could be severe. Prevention begins by detailed surgical planning. Peroperative imaging is helpful. Any suspected vertebral artery injury should postpone a contralateral approach before angiographic imaging.     

两种颈前路减压融合术治疗两节段脊髓型颈椎病的疗效分析

目的:探讨颈前路椎间盘切除融合术(anterior cervical discectomy with fusion,ACDF)与颈前路椎体次全切减压融合术(anterior cervical corpectomy with fusion,ACCF)治疗相邻两节段脊髓型颈椎病的临床疗效。方法:对2016年1月至2017年12月收治的相邻两节段脊髓型颈椎病37例患者的临床资料进行回顾性分析,男15例,女22例,年龄43～69岁,平均54.6岁。根据手术方法的不同分为ACDF治疗组(A组,17例)和ACCF治疗组(B组,20例)。记录两组患者的手术时间、术中出血量,比较两组患者术前及术后1、12个月颈椎融合节段Cobb角、颈椎曲度,采用日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分评价临床疗效,并观察两组术后并发症情况。结果:所有患者获得随访,时间12～24个月,平均18.5个月。手术时间、术中出血量A组分别为(106.3±22.6) min、(52.2±26.4) ml,B组分别为(115.6±16.8) min、(61.7±20.7) m...     

Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases

Background

Postoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease.

Methods

We included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation.

Results

There were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01).

Conclusions

To avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.     

Prospective comparison of dysphagia following anterior cervical discectomy and fusion (ACDF) with and without rhBMP-2

BACKGROUND CONTEXTPrevious studies have called into question the safety of using rhBMP-2 in anterior cervical fusion due to the possibility of airway compromise and dysphagia. A retrospective chart review identified a significant increase in the severity of dysphagia after II-level ACDF with rhBMP-2 compared to patients who did not receive rhBMP-2. To date, this topic has not been studied prospectively.PURPOSECompare the incidence of dysphagia following anterior cervical discectomy and fusion (ACDF) when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used with allograft compared to allograft alone.STUDY DESIGNProspective cohort study.PATIENT SAMPLEA total of 114 patients completed a baseline SWAL-QOL survey and met the inclusion criteria. Thirty-nine patients underwent I- or II-level ACDF with allograft plus 0.5mg rhBMP-2/level. 44 patients underwent ACDF with allograft alone. Thirty-one patients undergoing a lumbar decompression were enrolled in a third cohort to control for dysphagia secondary to intubation.OUTCOME MEASURESThe primary outcome measure was the 14-point SWAL-QOL dysphagia questionnaire. Other patient factors obtained from anesthesia and operative records were examined to evaluate their potential relationship to postoperative dysphagia.METHODSThe 14-point SWAL-QOL questionnaire was administered at multiple time points (pre-op, post-op 7 days, 6 weeks, 6 months, and at least 1 year). Multivariable repeated-measures analysis was applied to data.RESULTSBaseline adjusted SWAL-QOL means 7 days after surgery were significantly different between the three study groups. These differences resolved by 6 weeks postoperative, beyond which point there were no differences. At final follow-up, baseline adjusted SWAL-QOL means at 1 year were similar for the three study groups.CONCLUSIONSThis single-center study of anterior cervical surgery demonstrated that the addition of rhBMP-2 to an ACDF increased postoperative dysphagia at 7 days after surgery, but these patients recover to levels comparable to those who underwent ACDF without rhBMP-2 or lumbar surgery within 6 weeks.     

前路联合术式与后路单开门治疗3节段脊髓型颈椎病的疗效观察

目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效。方法:对2014年3月至2016年3月手术治疗的63例(男39例,女24例)3节段脊髓型颈椎病患者的临床资料进行回顾性分析,其中43例行ACDF联合ACCF(前路组),20例行颈后路单开门微型钛板内固定术(后路组)。比较两组患者的手术时间、术中出血量、术后并发症发生率,并按照JOA评分标准评定两组患者的临床疗效。结果:所有病例获得随访,时间16~40个月,平均25.8个月。前路组与后路组患者手术时间分别为(123.70±6.21)min和(118.70±5.41)min,差异无统计学意义(P0.05);术中出血量分别(85.23±7.51)ml和(107.18±9.41)ml,差异有统计学意义(P0.05)。前路组发生轴性症状6例,吞咽困难1例,未发生C5神经根麻痹、声音嘶哑及呛咳等并发症,并发症发生率为16.3℅(7/43);后路组发生轴性症状5例,C5神经根麻痹1例,未发生吞咽困难、声音嘶哑及呛咳等并发症,并发症发生率为30.0℅(6/20),两组并发症发生率比较差异有统计学意义(P0.05)。前路组术后1周及末次随访时的JOA评分均优于后路组(P0.05)。结论 :两种手术方式治疗脊髓型颈椎病均能提供即刻的稳定性,前路联合手术在术中出血量、并发症发生率、临床疗效方面均优于后路组,因此对于连续性3节段脊髓型颈椎病的治疗倾向于前路联合手术。     

Instrumented Outpatient Anterior Cervical Discectomy and Fusion: Is it Safe?

Anterior cervical discectomy and fusion procedures are one of the most common procedures performed in spinal surgery. Increasingly they are being performed on an outpatient basis. The primary impetus for performing procedures as an outpatient is potential cost savings. However, there are few studies discussing the safety of performing the procedure in an ambulatory setting. This is a retrospective review of our initial experience in performing anterior cervical discectomy and fusion procedures with instrumentation (ACDFI) in an ambulatory surgery center dedicated to spine surgery. Patients were selected for outpatient surgery if they had limited co-morbidities and the surgery involved only 1 or 2 levels. One hundred fifty-two patients underwent outpatient ACDFI during the study period (2007–2009). Six patients returned to the hospital emergency room after discharge. The reasons for evaluation included 2 for neck pain, 1 for dysphagia, 1 for vocal cord paralysis and dysphagia, 1 for nausea, and 1 for cervical swelling. Only 1 of the 6 patients required admission to the hospital. None of the 6 suffered any long-term sequelae. The overall complication rate was 3.9%. A self-reported survey was completed by 75 patients within 6 months of surgery, and there was a 100% satisfaction rate among responders. ACDFI can be performed safely on an outpatient in selected patients with a high degree of patient satisfaction. Our experience is consistent with those of previous investigators.     

脊髓损伤后神经轴突导向分子Semaphorin 3A表达的研究

目的:研究后脊髓损伤大鼠Semaphorin 3A表达的变化,探索脊髓损伤后轴突再生受到抑制的可能机制.方法:40只雌性健康SD大鼠,8周龄,体质量(210.00±9.88)g,随机分为对照组(A组,20只)和模型组(B组,20只).A组仅切开T10全椎板及T9、T11部分椎板,对脊髓未作其他处理;B组切开T10全椎板...     

Biomechanics of an integrated interbody device versus ACDF anterior locking plate in a single-level cervical spine fusion construct

Background contextNo profile, integrated interbody cages are designed to act as implants for cervical spine fusion, which obviates the need for additional internal fixation, combining the functionality of an interbody device and the stabilizing benefits of an anterior cervical plate. Biomechanical data are needed to determine if integrated interbody constructs afford similar stability to anterior plating in single-level cervical spine fusion constructs.PurposeThe purpose of this study was to biomechanically quantify the acute stabilizing effect conferred by a single low-profile device design with three integrated screws (“anchored cage”), and compare the range of motion reductions to those conferred by a standard four-hole rigid anterior plate following instrumentation at the C5–C6 level. We hypothesized that the anchored cage would confer comparable postoperative segmental rigidity to the cage and anterior plate construct.Study designBiomechanical laboratory study of human cadaveric spines.MethodsSeven human cadaveric cervical spines (C3–C7) were biomechanically evaluated using a nondestructive, nonconstraining, pure-moment loading protocol with loads applied in flexion, extension, lateral bending (right+left), and axial rotation (left+right) for the intact and instrumented conditions. Range of motion (ROM) at the instrumented level was the primary biomechanical outcome. Spines were loaded quasi-statically up to 1.5 N-m in 0.5 N-m increments and ROM at the C5–C6 index level was recorded. Each specimen was tested in the following conditions:1. Intact2. Discectomy+anchored cage (STA)3. Anchored cage (screws removed)+anterior locking plate (ALP)4. Anchored cage only, without screws or plates (CO)ResultsROM at the C5–C6 level was not statistically different in any motion plane between the STA and ALP treatment conditions (p>.407). STA demonstrated significant reductions in flexion/extension, lateral bending, and axial rotation ROM when compared with the CO condition (p<.022).ConclusionsIn this in vitro biomechanical study, the anchored cage with three integrated screws afforded biomechanical stability comparable to that of the standard interbody cage+anterior plate cervical spine fusion approach. Due to its low profile design, this anchored cage device may avoid morbidities associated with standard anterior plating, such as dysphagia.