Anterior cervical Discectomy and fusion associated complications
Anterior cervical Discectomy and fusion associated complications
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DOI：
10.1097/brs.0b013e318154c57e
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发表时间：
2007-10-01
期刊：
影响因子：
3
通讯作者：
Robinson, Joe S.
中科院分区：
文献类型：
--
作者：
Fountas, Kostas N.;Kapsalaki, Eftychia Z.;Robinson, Joe S.
研究设计。回顾性研究与文献回顾。目的。我们当前研究的目的是提高对颈椎前路椎间盘切除术和融合（ACDF）相关并发症的认识，以及早期发现和适当处理。背景资料摘要。众所周知，ACDF是最常见的脊柱手术之一。在大多数情况下，其结果是相当令人满意的。然而，偶尔的并发症会变得很麻烦，在极少数情况下，甚至是灾难性的。虽然有一些病例报告描述了这些并发症，但其发生率通常被低估，并且缺乏关于其在大型临床系列中的确切发生率的数据。对术中和术后acdf相关并发症的详细了解是至关重要的，以便尽可能避免这些并发症，并在不可避免的情况下成功安全地处理它们。在一项回顾性研究中，对1015例因退行性椎间盘疾病和/或颈椎病引起的颈椎神经根病和/或脊髓病首次行ACDF的患者进行了评估。所有患者均采用标准Smith-Robinson入路，同时采用自体或同种异体移植，带或不带钢板。我们回顾了手术报告、医院和门诊图表以及放射学研究，以了解手术相关的并发症。平均随访时间26.4个月。在我们目前的研究中，死亡率为0.1%（1015例患者中有1例继发于食管穿孔）。总发病率为19.3%（196 / 1015）。最常见的并发症是术后孤立性吞咽困难，9.5%的患者出现这种情况。术后血肿发生率为5.6%，但需要手术干预的病例仅占2.4%。有症状的喉返神经麻痹发生率为3.1%。硬脑膜穿透发生率为0.5%，食管穿孔发生率为0.3%，既往脊髓病加重发生率为0.2%，霍纳氏综合征发生率为0.1%，器械退出发生率为0.1%，浅表伤口感染发生率为0.1%。对acdf相关并发症的细致了解有助于对其进行适当的管理。术后吞咽困难、血肿和喉返神经麻痹是本系列中最常见的并发症。在我们的病例中，绝大多数并发症的处理是成功的。
Study Design. Retrospective review study with literature review.Objective. The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management.Summary of Background Data. It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable.Methods. In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months.Results. The mortality rate in our current series was 0.1% ( 1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3% ( 196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5% of our patients. Postoperative hematoma occurred in 5.6%, but required surgical intervention in only 2.4% of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1% of our cases. Dural penetration occurred in 0.5%, esophageal perforation in 0.3%, worsening of preexisting myelopathy in 0.2%, Horner's syndrome in 0.1%, instrumentation backout in 0.1%, and superficial wound infection in 0.1% of our cases.Conclusion. Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.