Choice and management of negative pressure drainage in anterior cervical surgery

BACKGROUND Postoperative unobstructed drainage is an important measure for avoiding hematoma formation and preventing complications from anterior cervical surgery.AIM To discuss the characteristics and key points of clinical management of two types of commonly used negative pressure drainage systems in clinical settings.METHODS Two types of commonly used silica gel negative pressure drainage balls and a type of gastrointestinal decompression apparatus were fully emptied and then injected with different amounts of water and air.Following this,the negative pressure values of the three devices were measured.Meanwhile,we undertook a retrospective analysis of the clinical data of 1328 patients who had been treated with different negative pressure drainage apparatuses during their anterior cervical surgery in our department between January 2007 and January 2018.RESULTS As the amount of injected air or water increased,the negative pressure of the silica gel negative pressure drainage ball decreased rapidly,dropping to zero when 150 mL of water or air was injected.In contrast,the negative pressure of gastrointestinal decompression apparatus decreased slowly,maintaining an ideal value even when 300 mL of water or air was injected.And statistical analysis demonstrated that patients who had been treated with the gastrointestinal decompression apparatus were less likely to develop severe complications than those who had been treated with the silica gel negative pressure drainage ball(P<0.05).CONCLUSION This study showed that the gastrointestinal decompression apparatus has the advantages of large suction capacity,long duration of continuous negative pressure,and good drainage effect,all of which are the favorable factors for the use of this apparatus for negative pressure drainage in anterior cervical surgery.

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery:Four case reports

BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

颈椎内固定术后咽食管憩室1例

1临床资料患者,男,65岁,因“咽部不适1年余,进行性加重2周”入院。患者1年前出现咽部不适,无咽痛、声嘶,近2周出现饮食饮水呛咳,遂至潍坊市人民医院耳鼻咽喉科行钡餐检查示(图1A):食管上端前部有一较大的囊袋样憩室充盈,压迫局部食管变窄,钡剂通过受阻、部分造影剂逆行向前上方反流进入喉及气管和支气管内。后为求进一步治疗就诊于我院胸外科门诊,以“食管憩室”收治入院。患者既往白癜风病史20年余,自发病以来偶有呛咳和食管反流症状,曾于2015年7月因外伤于当地医院行颈部钢板固定术,钢板未取出。其余无特殊。经胸外科联系我科、脊柱外科、消化内科进行多学科会诊,讨论结果为:患者钡餐考虑食管憩室,诊断明确。消化内科建议因食管憩室较高,行食管支架手术后支架存在脱落可能性较大,暂不考虑行支架治疗。我科会诊建议:患者目前咽喉反流严重,考虑为憩室压迫所致,可转我科行手术治疗,术中请脊柱外科医师同台手术取出脊柱钢板。后患者及家属同意转至我科进一步手术治疗,术前再次行颈部增强CT及MRI检查明确颈部情况(图1B,图1C)。排除手术禁忌后,联合脊柱外科、麻醉科于2021-01-19全麻下行“食管憩室切除术+颈椎内固定取出术”。

Influence of developmental cervical stenosis on dural sac space

Background This retrospective study aimed to investigate the difference of the intra-dural reserving space for spinal cord in magnetic resonance imaging （MRI） between patients with and without developmental cervical stenosis and its clinical significance.Methods A total of 264 patients with cervical spondylotic myelopathy who had decompression surgeries were recruited.The average follow-up was 29 months.Based on their lateral radiographs,they were divided into stenosis group and non-stenosis group.On the magnetic resonance images,the ratio of the sagittal diameter of the dural sac to that of the vertebral body was measured and calculated as MRI Pavlov ratio at the mid-vertebral level on T2-weighted sagittal images from C3 to C7.The ratio of the transverse area of the spinal cord to that of the dural sac was measured and calculated as occupation ratio on T2-weighted axial images at the same levels.The MRI Pavlov ratio and occupation ratio were compared between the two groups.The stenosis group was further divided into space-reserving and non-space-reserving subgroups based on the occupation ratios; then clinical parameters were compared between the two subgroups to determine the clinical significance of the reserving space.Results The MRI Pavlov ratio of the stenosis group was significantly smaller than that of the non-stenosis group at C3-C7 （P ＜0.01）,while the occupation ratio was significantly larger only at C7 （P ＜0.05）.For the space-reserving subgroup,the postoperative recovery rate was lower （P ＜0.05）.The postoperative recovery rate was （23±6）％ in anterior approach,larger than （-23±15）％ in posterior approach （P ＜0.05）.Conclusions Developmental cervical stenosis is associated with a smaller sagittal diameter of the dural sac,but does not lead to a significant decrease in intra-dural space available for the cord.For patients with normal intra-dural space,the recovery after anterior decompression surgery was better than posterior approach.