Objective To investigate the safety and efficacy of different doses of tranexamic acid (TXA) in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion by a prospective clinical study. Methods The middle-aged and elderly patients with cervical spondylotic myelopathy, who were admitted between January 2020 and January 2022 and scheduled to undergo posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion, were studied as the research subjects. Among them, 165 patients met the selection criteria and were included in the study. The patients were allocated into 3 groups (n=55) by random double-blind lottery. Groups A and B were given intravenous infusion of TXA at 30 minutes before operation according to the standards of 15 and 30 mg/kg, respectively; and group C was given normal saline in the same way. There was no significant difference in gender, age, body mass index, and preoperative D-dimer, hemoglobin (Hb), and hematocrit (HCT) between groups (P>0.05). The intraoperative bleeding, intraoperative blood transfusion, postoperative drainage volume, drainage days, and postoperative hospital stay were recorded. The Hb, HCT, and D-dimer were compared before operation and at 3 days after operation. Venous ultrasonography of the lower extremities was taken after operation to assess thrombosis; and the postoperative hematoma and epilepsy were also observed. Results All operations were successfully completed, and the incisions healed by first intention. The differences in intraoperative bleeding volume, postoperative drainage volume, drainage days, and postoperative hospital stay between groups were significant (P<0.05). The above indexes were significantly less in group B than in groups A and C. During operation, 14 patients in group A and 23 patients in group C were transfused, and no patient in group B had blood transfusions. Compared with groups A and C, the blood transfusion volume in group B significantly decreased (P<0.05), and the difference between groups A and C was not significant (P>0.05). There was no significant difference in the differences of D-dimer, Hb, and HCT before and after operation between groups (P>0.05). At 5 days after operation, the venous ultrasonography of the lower extremities showed that the 2 cases of intermuscular venous thrombosis occurred in groups A, B, and C, respectively. No hematoma or epilepsy occurred after operation. Conclusion The application of 15 and 30 mg/kg TXA in posterior cervical laminectomy with lateral mass screw fixation and bone graft fusion can reduce intraoperative bleeding and postoperative drainage volume, postoperative drainage days, and postoperative hospital stay. And application of 30 mg/kg TXA can reduce intraoperative blood transfusion, without increasing the risk of lower extremity venous thrombosis, hematoma, and epilepsy.
Objective To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness. Methods A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting (n=35, outpatient setting group) or in inpatient setting (n=35, inpatient setting group). There was no significant difference between the two groups (P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10. Results The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group (P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group (P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss (P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation (P<0.05). There was no significant difference in the improvement of the above scores between the two groups (P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference (t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups. Conclusion The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients’ medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.
ObjectiveTo review the research progress of C5 palsy (C5P) after cervical surgery, providing new clinical intervention ideas for the C5P patients. MethodsThe relevant literature domestically and abroad was extensively consulted and the latest developments in the incidence, risk factors, manifestations and diagnosis, prevention, and intervention measures of C5P were systematically expounded. ResultsC5P is characterized by weakness in the C5 nerve innervation area after cervical decompression surgery, manifested as limited shoulder abduction and elbow flexion, with an incidence rate more than 5%, often caused by segmental spinal cord injury or mechanical injury to the nerve roots. For patients with risk factors, careful operation and preventive measures can reduce the incidence of C5P. Most of the patients can recover with conservative treatment such as drug therapy and physical therapy, while those without significant improvement after 6 months of treatment may require surgical intervention such as foraminal decompression and nerve displacement. ConclusionCurrently, there has been some advancement in the etiology and intervention of C5P. Nevertheless, further research is imperative to assess the timing of intervention and surgical protocol.
Getting out of bed early after surgery is an important measure to promote the clinical concept of accelerated rehabilitation surgery and promote physical and mental rehabilitation of patients. However, at present, the specific implementation plan for early postoperative ambulation of patients undergoing anterior cervical surgery has not formed a unified standard, and there is a lack of reliable evidence to recommend and guide clinical nursing practice. To this end, the Orthopaedic Nursing Professional Committee of Chinese Nursing Association, the Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Rehabilitation Medical Association, and the Nursing Group of Orthopaedic Professional Committee of Sichuan Medical Association, based on evidence-based medical evidence and combined with the clinical experience of experts in related fields, formed an expert consensus on the theme of early postoperative get-out activities of patients undergoing anterior cervical surgery. To provide reference for clinical work, 9 recommendations on early ambulation of patients undergoing anterior cervical surgery were put forward.