Comparison of Chronic Dysphagia in Standalone versus Conventional Plate and Cage Fusion
Comparison of Chronic Dysphagia in Standalone versus Conventional Plate and Cage Fusion
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DOI：
10.1016/j.wneu.2017.09.188
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Chapman, Jens R.
中科院分区：
文献类型：
--
作者：
Fisahn, Christian;Schmidt, Cameron;Chapman, Jens R.
简介：与传统钢板和椎间融合器系统相比，独立式椎间融合器因其易于植入、手术时间缩短和切迹更小而受到欢迎。本研究的目的是比较接受传统钢板技术的颈椎前路椎间盘切除融合术（ACDF）和接受独立手术的患者发生慢性吞咽困难的风险。材料和方法：2014年至2015年，我们确定了377例符合研究标准的连续患者（独立手术，n = 211;钢板-融合器，n = 166）。术前收集患者特异性特征和手术特征。此外，吞咽困难功能障碍指数（DDI）收集2年后，通过电话interview.Results：在接受独立程序的患者中，84%（n = 177）可用于其2年随访访视，相比之下，75%（n= 124）的钢板融合器程序。在控制既往手术和吸烟的情况下，两组之间的术后DDI评分无统计学显著差异。然而，DDI评分较高的最强风险因素是既往颈椎手术（平均高6.0分）和吸烟（平均高6.2分）。27例患者（8.9%）发生慢性吞咽困难。钢板-融合器组的风险更高（n = 15，12.1%）比独立治疗组（n = 12，6.7%），但差异无统计学意义。尽管平均DDI评分相似，但使用钢板-融合器进行颈椎前路椎间盘切除术的患者发生慢性吞咽困难的风险可能高于使用独立方法的患者，但需要更大样本量的进一步研究，以更大的置信度建立这种关系。
INTRODUCTION: Standalone cages have gained popularity because of their ease of implantation, reduced operating time, and lower profile compared with traditional plate and cage systems. The aim of this study was to compare the risk of chronic dysphagia between those who undergwent anterior cervical discectomy and fusion (ACDF) with traditional plating techniques and those who underwent standalone procedures.MATERIAL AND METHODS: Between 2014 and 2015, we identified 377 consecutive patients who met the study criteria (standalone, n = 211; plate-cage, n = 166). Patient-specific characteristics and surgical characteristics were collected preoperatively. In addition, the Dysphagia Disability Index (DDI) was collected 2 years postoperatively by telephone interview.RESULTS: Among the patients who underwent a standalone procedure, 84% (n = 177) were available for their 2-year follow-up visit in comparison with 75% (n= 124) for plate-cage procedures. There was no statistically significant difference in postoperative DDI scores between the 2 groups, controlling for prior surgery and smoking. However, the strongest risk factors for higher DDI scores were prior cervical surgery (mean 6.0 points higher) and smoking (mean 6.2 points higher). Twenty-seven patients (8.9%) experienced chronic dysphagia. The risk was higher in the plate-cage group (n = 15, 12.1%) than in the standalone group (n = 12, 6.7%), but this difference did not reach statistical significance.CONCLUSION: Despite similar mean DDI scores, patients who undergo anterior cervical discectomy with a plate-cage may be at a higher risk for chronic dysphagia than are those with a standalone approach, but further studies with larger sample sizes are necessary to establish this relationship with greater confidence.