Incidence of dysphagia comparing cervical arthroplasty and ACDF.
Incidence of dysphagia comparing cervical arthroplasty and ACDF.
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DOI：
10.1016/j.esas.2009.12.001
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Ponce C
中科院分区：
文献类型：
--
作者：
Segebarth B;Datta JC;Darden B;Janssen ME;Murrey DB;Rhyne A;Beckham R;Ponce C
随机前瞻性临床试验的回顾性队列研究。评估内固定ACDF和无轮廓颈椎关节置换术之间吞咽困难的发生率。吞咽困难是颈椎前路髓核摘除融合术(ACDF)后常见的并发症，其病因是多因素的。术后吞咽困难的一个潜在来源涉及所使用的植入物的前侧面。因此，从理论上讲，无轮廓颈椎间盘成形术可以减少软组织粘连，降低吞咽困难的发生率。本研究的目的是比较ACDF前路钢板置换术和无轮廓颈椎关节置换术后至少一年吞咽困难的发生率。符合ProDisc-C与ACDF的前瞻性、随机、多中心IDE试验纳入标准的87名患者接受了吞咽困难的评估。45名患者随机接受颈椎关节置换术，42名患者随机分为ACDF+钢板组。在完成至少12个月的随访后，采用盲法进行Bazaz-Yoo吞咽困难问卷调查。平均随访时间为18.2个月，87名入选患者中有76名(87%)，其中关节成形术组45名中有38名，ACDF组42名中有38名。关节成形术组38人中有6人(15.8%)报告持续吞咽困难，而ACDF组38人中有16人(42.1%)报告持续吞咽困难。这被发现具有统计学意义(P=0.03)。这项研究表明，对于C3-7之间的单节段颈椎疾病，无轮廓颈椎关节置换术的吞咽困难发生率明显低于器械ACDF。虽然有许多潜在的病因，但我们推测这与咽后间隙缺乏前硬件有关。手术技巧、手术时间和显著的中线回缩似乎并没有导致更多的吞咽困难症状。未来比较颈椎间盘置换术和无侧位融合器的研究可能有助于描述前路内固定侧位对术后吞咽困难的影响。
Retrospective cohort from randomized prospective clinical trial. Evaluate incidence of dysphagia between instrumented ACDF and a no-profile cervical disc arthroplasty. Dysphagia is a well-known complication following anterior cervical discectomy and fusion (ACDF) and the etiology is multifactorial. One potential source for postoperative dysphagia involves the anterior profile of the implant used. Hence, a no-profile cervical disc arthroplasty could theoretically have fewer soft tissue adhesions and a lower incidence of dysphagia. The purpose of this study is to compare the incidence of dysphagia at least 1 year postoperatively following ACDF with anterior plating and a no-profile cervical disc arthroplasty. A cohort of 87 patients meeting the inclusion criteria for the prospective, randomized, multicenter IDE trial of ProDisc-C versus ACDF were evaluated for dysphagia. Forty-five patients were randomized to receive cervical arthroplasty and 42 patients were randomized to the ACDF and plate group. The Bazaz-Yoo dysphagia questionnaire was administered in a blinded fashion after completion of at least 12 months follow-up. Follow-up averaged 18.2 months and included 76 (87%) of the 87 enrolled, with 38 of the original 45 in the arthroplasty group and 38 of the original 42 in the ACDF group. Six of 38 (15.8%) in the arthroplasty group versus 16 of 38 (42.1%) in the ACDF group reported ongoing dysphagia complaints. This was found to be statistically significant (P = .03). This study suggests a significantly lower rate of dysphagia with a no-profile cervical disc arthroplasty compared to instrumented ACDF for single level disc disease between C3-7. Though there are many potential etiologies, we hypothesize this is related to the lack of anterior hardware in the retropharyngeal space. Operative technique, operating time, and significant midline retraction did not seem to result in more dysphagia complaints. Future studies comparing cervical disc arthroplasty and no-profile fusion devices may help delineate the effect that anterior instrumentation profile has on postoperative dysphagia.