Comparison of Outcomes for Anterior Cervical Discectomy and Fusion With and Without Anterior Plate Fixation

Oliver, Jeremie D.; Goncalves, Sandy; Kerezoudis, Panagiotis; Alvi, Mohammed Ali; Freedman, Brett A.; Nassr, Ahmad; Bydon, Mohamad

doi:10.1097/brs.0000000000002441

Cited by 102 publications

(105 citation statements)

References 33 publications

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“…Domestic studies concerning the mechanisms of postoperative dysphagia development in short-and long-term outcomes after cervical spine surgery were relatively few. Many potential risk factors have been reported, including age 1,2 , gender 3,4 , intraoperative esophagus traction 5,6 , long segmental surgery 7,8 , postoperative persistent pain 9,10 , prolonged procedure time 11 , high surgical position 12 , revision surgery 13 , esophageal intubation , and massive blood loss 15 . In addition, other risk factors were associated with dysphagia development such as thickness of internal plate 16 , intraoperative injury of esophagus 17 , postoperative cervical hematoma formation 18 , the use of BMP-2 19 , postoperative soft swelling 20 , scar formation and tissue adhesion 21 , internal compression of the esophagus 22 and recurrent laryngeal nerve injury [23][24][25] .…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Tao

2020

Preprint

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Background. Dysphagia is a known complication of anterior cervical spine surgery and may be prolonged or occasionally serious. However, the association between posterior cervical spine surgery and the development of dysphagia is rare discussed. Furthermore, the risk factors of postoperative dysphagia are not well understood.Methods. Three hundred and fifty four patients were reviewed in this study, including 172 patients undergoing AC procedure, and 182 patients with PC procedure between June 2007 and May 2012. All patients were given the same postoperative management. The presence and severity of dysphagia were reported during the telephone interviews performed at 1, 3, 6, and 12 months after the procedure. The incidence and risk factors of dysphagia after cervical spine surgery were studied. Results. Of all 354 patients, 12.8% AC and 9.4% PC patients reported dysphagia at early postoperative assessment. The overall incidence for dysphagia at 1, 3, 6 and 12 months were decreased to 9.3%, 7.0%, 4.6% and 3.5% in AC group, and 6.0%, 4.4%, 2.2% and 1.6% in PC group, respectively. Long term use of Neck Collar after surgery may lead to postoperative dysphagia. Other risk factors such as age, gender, BMI, operative time, blood loss, procedure type, revision surgery and operative levels did not signiﬁcantly influence the incidence of postoperative dysphagia.Conclusions. Postoperative dysphagia is common after anterior and posterior cervical spine surgery. The incidence and severity of dysphagia both decrease over time. Long term use of neck collar after surgery is related of postoperative dysphagia. The neck collar should be worn no longer than four weeks after surgery. Age, gender, BMI, operative time, blood loss, procedure type, revision surgery and operative levels are not risk factors of postoperative dysphagia.

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Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Tao

2020

Preprint

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“…ACDF is a classic procedure in treating cervical degenerative diseases that can remove the prominent disc, osteophyte, and relieve the compressions of spinal cord and nerve root. It is effective and widely used in the treatment of patients with cervical degenerative disc disease (CDDD) [1]. Anterior plating system not only stabilizes the upper and lower vertebral bodies, but also improves the rate of intervertebral fusion and avoids the risk of pseudarthrosis [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Anterior cervical discectomy and fusion (ACDF) is the standard surgical procedure for cervical degenerative disc disease (CDDD) [1]. The use of anterior plate can increase the stability of cervical spine, promote early intervertebral fusion after surgery, and is widely used in clinical practice [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

Fang

Shen

et al. 2019

Preprint

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Background Zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate?Methods We performed a meta-analysis of studies which compared the subsidence rate of ZP and CP. An extensive and systematical search covered Medline, Embase and Web of Science databases according to PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analysed by RevMan 5.3 software.Results Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in ZP group was significantly higher than with CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multi-level surgery. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate and cervical aligment in the final followup between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia at each follow-up time than the ZP group.Conclusion ZP had a higher risk of postoperative subsidence than CP. Although there was a high occurrence of swallowing discomfort, we are more agreed that the anterior plate should be used in multi-level surgery as far as possible to reduce the subsidence and adverse clinical symptoms in the long term.

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“…Discussion ACDF is a classic procedure in treating cervical degenerative diseases that can remove the prominent disc and osteophyte and relieve compressions of the spinal cord and nerve root. It is effective and widely used in the treatment of patients with CDDD [1]. The anterior plating system not only stabilizes the upper and lower vertebral bodies, but also improves the rate of intervertebral fusion and avoids the risk of pseudarthrosis [3,4].…”

Section: Subsidencementioning

confidence: 99%

“…Anterior cervical discectomy and fusion (ACDF) is the standard surgical procedure for cervical degenerative disc disease (CDDD) [1]. The use of the anterior plate can increase the stability of the cervical spine and promote early intervertebral fusion after surgery, and it is widely used in clinical practice [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

Fang

et al. 2020

Preprint

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Background: The zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate.Methods: We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the Medline, Embase and Web of Science databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by RevMan 5.3 software.Results: Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multilevel (≥ 2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time. Conclusion: Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multi-center randomized controlled trial is required to validate our results in the future.

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Comparison of Outcomes for Anterior Cervical Discectomy and Fusion With and Without Anterior Plate Fixation

Abstract: 3.

Cited by 102 publications

References 33 publications

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

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