Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Lee, Subum; Cho, Dae-Chul; Chon, Haemin; Roh, Sung Woo; Choi, In Suck; Park, Jin Hoon

doi:10.3340/jkns.2020.0263

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…In addition, cervical disc placement appears to require less esophageal friction and reduces esophageal pressure when compared to anterior plaque placement [39]. The reported rates of postoperative dysphagia are significantly higher in ACDF in comparison with posterior decompression and fusion [40][41][42]. Multiple cervical levels of ACDF represent a significantly higher postoperative risk for swallowing dysfunction, as compared with one-level ACDF [18,20,43].…”

Section: Surgical Approachmentioning

confidence: 99%

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Tsalimas¹,

Evangelopoulos²,

Benetos³

et al. 2022

Cureus

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Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate.The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: "dysphagia" and "anterior cervical discectomy and fusion" or "ACDF". The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded.Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.

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Section: Surgical Approachmentioning

confidence: 99%

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Tsalimas¹,

Evangelopoulos²,

Benetos³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…In patients with radiculopathy due to foraminal disc herniation or stenosis, surgery is recommended when non-surgical treatment is not effective [ 1 – 4 ]. Currently, surgical options include anterior cervical discectomy fusion (ACDF), artificial disc replacement, and posterior micro-foraminotomy [ 4 – 7 ]. Although ACDF and artificial disc replacement are well-established and popular surgical methods, surgery without instrumentation while preserving cervical motion would be a good alternative to those surgical methods [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis

et al. 2023

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Objective Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF. Methods Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24–113 months). Results Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years. Conclusion Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.

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“…Despite its efficacy, the anterior approach associated with ACDF can lead to certain complications. Dysphagia and hoarseness are most common 1) , but more severe complications could arise. One severe, though rare, complication includes the inadvertent perforation of the cervical esophagus or hypopharynx.…”

Section: Introductionmentioning

confidence: 99%

Early Detection and Urgent Surgical Repair of Pharyngeal Injury after Anterior Cervical Surgery: A Case Report

Jung,

Lee,

Hur

et al. 2023

J Neurointensive Care

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This case report addresses pharyngeal perforation, an uncommon complication after anterior cervical discectomy and fusion (ACDF). A 78-year-old male, who initially presented with quadriparesis, underwent ACDF. Post-surgery, the porridge he consumed was observed in the drain tube, leading to complications such as respiratory distress and fever. An emergency exploratory surgery was performed, and a suspected pharyngeal perforation was identified and treated with primary repair and sternocleidomastoid flap. Through thorough post-operative observation, we identified critical signs requiring immediate intervention, allowing for a successful recovery without additional complications. This report emphasizes the importance of early detection and intervention for complications following ACDF, providing valuable insights for clinical practice in neurosurgical intensive care.

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Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Cited by 4 publications

References 32 publications

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis

Early Detection and Urgent Surgical Repair of Pharyngeal Injury after Anterior Cervical Surgery: A Case Report

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