Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication

Abstract

Study Design:Retrospective multi-institutional case series.Objective:The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.Methods:A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections.Results:A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities.Conclusion:The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series.

Anterior cervical spine surgical site infection and pharyngoesophageal perforation. Ten-year incidence in 1475 patients

“…The revision rate for surgical site infection following anterior spinal surgery in the present series was 0.34%, comparable to international reports of rates between 0.07% and 1.6% [7][8][9].…”

“…Ghobrial et al [9], in a retrospective series, reported 6 septic complications in 8887 cases in 21 US centers, for a mean septic complication rate of 0.07% (range: 0-0.39%). Fountas et al [7], in a retrospective series of 1015 patients, reported a single early abscess (0.15%), as did Bertalanffy and Eggert [10] in a series of 450 patients (i.e., 0.2%).…”

Immediate Voice and Swallowing Complaints Following Revision Anterior Cervical Spine Surgery

“…Infections following ACDF are rare and require reoperation to address the infection. 20 Infection increases inflammation and difficulty of the operation; therefore, the possible increased risk of recurrent laryngeal nerve injury is not surprising. The association of C7/T1 with increased risk of injury is also not surprising given the anatomical course of the recurrent laryngeal nerve.…”

Preliminary results of anterior cervical arthroplasty by porous alumina ceramic cage for cervical disc herniation surgery

“…Finiels using the same implant in 61 patients reported any complication of this type[23] and this, notwithstanding the mean rate of infection is of 0.07%–1.6% in the medical literature. [25262728] Fusion rate is an important criterion for a good outcome. It varies from 71.4% to 92.1% for single-disc implant without instrumentation.…”