Spine · 2014
Infection rate after transoral approach for the upper cervical spine.
СтатьяНазвание и аннотация: Перевод в очереди
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Shousha Mootaz, Mosafer Azim, Boehm Heinrich
Аннотация
STUDY DESIGN: A retrospective review of prospectively collected databases of 139 consecutive patients who underwent transoral surgery for lesions of the upper cervical spine.
OBJECTIVE: To analyze the incidence and risk factors of local infection after transoral surgery for the craniocervical junction in a single institution and to compare the findings with the literature.
SUMMARY OF BACKGROUND DATA: One of the primary risks associated with transoral approach for lesions in the upper cervical spine is postoperative surgical wound infection.
METHODS: From April 1994 to December 2012, 139 consecutive transoral surgical procedures were performed at a single referral center. The mean age at presentation was 53.6 years (range: 5-87 yr), and more than half of the patients were males (58.3%). The majority of cases were experiencing rheumatic diseases (43.9%), whereas tumor destruction was the indication for surgery in 23.7% of the cases. A total of 23% had fracture of the upper cervical spine and primary infection was found in 7 patients (5%). The mean follow-up period was 4.5 years.
RESULTS: Infection of the pharyngeal wound occurred in 5 patients (3.6%), solely in the rheumatic and tumor groups. The presentation was mostly in the first 4 months. A single patient with cage reconstruction after giant cell tumor C2 presented with a late infection 5 years postoperatively. Debridement and primary closure was possible in 2 patients, whereas flap coverage of the pharyngeal wall was necessary in 3 patients. The presence of implant did not have a statistically significant effect on the occurrence of infection. However, infection in the presence of titanium cage mostly necessitated flap coverage of the pharyngeal wall after removal of the cage.
CONCLUSION: The transoral route has proved to be an invaluable method of approaching pathological lesions in the upper cervical spine. The infection rate in this work was 3.6%. Patients with rheumatic diseases and patients presenting with tumors were more susceptible to postoperative surgical wound infection.
LEVEL OF EVIDENCE: 4.
OBJECTIVE: To analyze the incidence and risk factors of local infection after transoral surgery for the craniocervical junction in a single institution and to compare the findings with the literature.
SUMMARY OF BACKGROUND DATA: One of the primary risks associated with transoral approach for lesions in the upper cervical spine is postoperative surgical wound infection.
METHODS: From April 1994 to December 2012, 139 consecutive transoral surgical procedures were performed at a single referral center. The mean age at presentation was 53.6 years (range: 5-87 yr), and more than half of the patients were males (58.3%). The majority of cases were experiencing rheumatic diseases (43.9%), whereas tumor destruction was the indication for surgery in 23.7% of the cases. A total of 23% had fracture of the upper cervical spine and primary infection was found in 7 patients (5%). The mean follow-up period was 4.5 years.
RESULTS: Infection of the pharyngeal wound occurred in 5 patients (3.6%), solely in the rheumatic and tumor groups. The presentation was mostly in the first 4 months. A single patient with cage reconstruction after giant cell tumor C2 presented with a late infection 5 years postoperatively. Debridement and primary closure was possible in 2 patients, whereas flap coverage of the pharyngeal wall was necessary in 3 patients. The presence of implant did not have a statistically significant effect on the occurrence of infection. However, infection in the presence of titanium cage mostly necessitated flap coverage of the pharyngeal wall after removal of the cage.
CONCLUSION: The transoral route has proved to be an invaluable method of approaching pathological lesions in the upper cervical spine. The infection rate in this work was 3.6%. Patients with rheumatic diseases and patients presenting with tumors were more susceptible to postoperative surgical wound infection.
LEVEL OF EVIDENCE: 4.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overCervical VertebraeChildChild, PreschoolDebridementDevice RemovalFemaleFollow-Up StudiesGiant Cell TumorsHumansIncidenceInternal FixatorsMaleMiddle AgedMouthOdontoid ProcessOral HygienePostoperative CareProstheses and ImplantsProsthesis-Related InfectionsRetrospective StudiesRheumatic DiseasesRiskSpinal FracturesSpinal NeoplasmsSpondylitisSurgical Wound Infection