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  • Anterior Cervical Spine Surgery-Associated Complications

    Final Number:

    Anastasia Tasiou MD, PhD; Theofanis Giannis MD; Ioannis Siasios; Iordanis Georgiadis; Eleni Tsianaka MD; Konstantinos Vagkopoulos; Haralampos Gatos; Konstantinos Paterakis; Kostas N. Fountas MD, PhD, FICS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Anterior cervical spine procedures have been associated with quite satisfactory outcome in the vast majority of cases. However, the occurrence of troublesome complications, although rare, needs to be taken into consideration. The purpose of our current study is to identify the actual incidence of any anterior cervical spine procedure-associated complications.

    Methods: A total of 114 patients (73M and 41F) with a mean age 49.8 years (range 21-82 years), were included in our retrospective study (January 2009 to December 2014). The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, following a standard Smith-Robinson approach. Intraoperative and postoperative complications were recorded. Mean follow-up time was 36.5 months (range 1-72 months).

    Results: Anterior cervical discectomy and fusion (ACDF) was the most commonly performed procedure (79%). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating and two patients (1.7%) odontoid screw fixation. One patient underwent surgery for severe Forestier’s disease. The overall complication rate was 13.2% (15 out of 114 patients). Specifically, we encountered superficial wound infection in one patient (0.9%), while remarkable postoperative soft tissue swelling and hematoma were observed in 1.7%. None of these cases required surgical intervention. Symptomatic recurrent laryngeal nerve palsy occurred in 0.9% of our cases, dural penetration in 1.7%, esophageal perforation in 0.9%, aggravation of preexisting myelopathy in 0.9%, abscess due to tracheoesophageal fistula in 0.9%, screw backout in 0.9%, and adjacent disc segment degeneration in 2.7%. Dysphagia was observed in 1.7% of them. No deaths occurred.

    Conclusions: In the majority of cases, anterior cervical spine surgery-associated complications are minor, requiring no further intervention. However, some of them can become disastrous. Awareness, early recognition, and appropriate management, are of paramount importance to improve the overall functional outcome in these patients.

    Patient Care: This research will be helpful by increasing alertness considering possible complications after anterior cervical spine surgery.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) identify the incidence of anterior cervical spine surgery-associated complications, 2) evaluate the functional outcome in these patients, 3) discuss about the fact that the occurrence of anterior cervical spine surgery-associated complications can occasionally be troublesome.

    References: 1. Fehlings MG, Smith JS, Kopjar B, et al: Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine 16:425-432, 2012. 2. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al: Anterior cervical discectomy and fusion associated complications. Spine 32:2310-2317, 2007. 3. Yang Liu, Min Qi, Huajiang Chen, Lili Yang,et al: Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J 21:2428–2435, 2012.

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