Dysphagia Prevention in Anterior Cervical Discectomy Surgery: Results from a Prospective Clinical Study.
Adult
Aged
Cervical Vertebrae
/ surgery
Deglutition Disorders
/ etiology
Diskectomy
/ methods
Esophagus
/ surgery
Female
Follow-Up Studies
Humans
Intubation, Intratracheal
/ methods
Male
Middle Aged
Postoperative Complications
/ epidemiology
Postoperative Period
Spinal Fusion
/ methods
Trachea
/ surgery
Anterior cervical discectomy surgery
Dysphagia
Preventive measures
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
03
01
2019
revised:
28
01
2019
accepted:
30
01
2019
pubmed:
23
2
2019
medline:
15
1
2020
entrez:
23
2
2019
Statut:
ppublish
Résumé
Dysphagia is a common complication after anterior cervical discectomy surgery (ACDS). Recent studies have shown that reducing the endotracheal tube cuff pressure, local irrigation with methylprednisolone, and minimizing the pharynx/esophagus retraction can decrease the incidence of postoperative dysphagia after ACDS. This is the first study assessing the efficacy of all these 3 measures simultaneously. This prospective study included 35 patients (group 1) who underwent ACDS with the adoption of all the 3 preventive measures. Group 1 was compared with a homogenous group of 35 patients who underwent regular ACDS (group 2). Postoperative dysphagia and odynophagia were evaluated after 2, 7, and 14 days and 3, 6, and 12 months. Age, gender, body mass index (BMI), operating time, blood loss, and preoperative Japanese Orthopaedic Association score were collected. Postoperative dysphagia was observed in 3 cases (8.6%) in group 1 and 15 cases (42.9%) in group 2 (P < 0.05). Three patients in group 1 had transient dysphagia with complete resolution at the last follow-up whereas 6 patients in group 2 (17.1%) had permanent dysphagia (P < 0.05). Nine patients (25.7%) in group 2 presented with transient dysphagia with complete resolution at the last follow-up. The mean visual analog scale for odynophagia was significantly lower in group 1 compared with group 2 (P < 0.05). Postoperative dysphagia occurs frequently after ACDS. We show that the adoption of preventive measures during surgery can reduce the rate of dysphagia. Future evaluations in a large clinical trial are mandatory.
Sections du résumé
BACKGROUND
Dysphagia is a common complication after anterior cervical discectomy surgery (ACDS). Recent studies have shown that reducing the endotracheal tube cuff pressure, local irrigation with methylprednisolone, and minimizing the pharynx/esophagus retraction can decrease the incidence of postoperative dysphagia after ACDS. This is the first study assessing the efficacy of all these 3 measures simultaneously.
METHODS
This prospective study included 35 patients (group 1) who underwent ACDS with the adoption of all the 3 preventive measures. Group 1 was compared with a homogenous group of 35 patients who underwent regular ACDS (group 2). Postoperative dysphagia and odynophagia were evaluated after 2, 7, and 14 days and 3, 6, and 12 months. Age, gender, body mass index (BMI), operating time, blood loss, and preoperative Japanese Orthopaedic Association score were collected.
RESULTS
Postoperative dysphagia was observed in 3 cases (8.6%) in group 1 and 15 cases (42.9%) in group 2 (P < 0.05). Three patients in group 1 had transient dysphagia with complete resolution at the last follow-up whereas 6 patients in group 2 (17.1%) had permanent dysphagia (P < 0.05). Nine patients (25.7%) in group 2 presented with transient dysphagia with complete resolution at the last follow-up. The mean visual analog scale for odynophagia was significantly lower in group 1 compared with group 2 (P < 0.05).
CONCLUSIONS
Postoperative dysphagia occurs frequently after ACDS. We show that the adoption of preventive measures during surgery can reduce the rate of dysphagia. Future evaluations in a large clinical trial are mandatory.
Identifiants
pubmed: 30794969
pii: S1878-8750(19)30392-4
doi: 10.1016/j.wneu.2019.01.273
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1176-e1182Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.