Complications of anterior cervical spine surgery: a systematic review of the literature

Yee, Timothy J; Swong, Kevin; Park, Paul

doi:10.21037/jss.2020.01.14

Cited by 140 publications

(137 citation statements)

References 254 publications

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“…Moreover, following the application of a long-segment titanium plate, patients are prone to foreign body sensation, dysphagia, and even esophageal fistula, while the incidence of ASD is also increased. [13][14][15][16][17][18] In the present study, our biomechanical results showed that among the three surgical models involving titanium plate fixation (mACDF, ACCF, and HDF groups), the ACCF group had the highest stress at the plate-screw interface, the HDF group had higher stress than the mACDF group, and the mACDF group had the lowest stress. These results revealed that the risk of titanium plate or screw loosening, displacement, and fracture was the highest following ACCF, which is similar to clinical results.…”

Section: Discussionsupporting

confidence: 49%

“…[11,30,41] However, this surgery involves a long operation time, has a limited field of view, and requires high surgical skills, making it difficult to ensure complete decompression in most cases. [13][14][15] ACCF involves long-segment decompression with slotting followed by long titanium mesh or autogenous bone grafting. The advantage of this approach is that it can be performed under direct vision, with a wider intraoperative view and larger operative field, and that it allows more extensive and thorough decompression.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, complications such as foreign body sensation in the anterior cervical region, dysphagia, and esophageal injury have been found after long-term follow-up. [13][14][15] Meanwhile, some researchers argue that the use of anterior cervical titanium plate increases the incidence of adjacent segment degeneration (ASD). [16][17][18] To prevent complications associated with anterior cervical titanium plates and maintain the benefits of interbody cages with anterior plating system, a new zero-profile, stand-alone device (Fidji cervical cage, and translated to various 3D solid volumes of all vertebrae.…”

Section: Introductionmentioning

confidence: 99%

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A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

Liu

Yang

Zhang

2021

Preprint

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Background: The decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM. Methods: An intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed. Results: Of the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress Conclusion: Among the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

Liu

Yang

Zhang

2021

Preprint

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“…A recent retrospective study conducted by Hershman et al found a prevalence of 0.02% in almost 9,600 procedures on the cervical spine via the anterior route [ 7 ]. In a systematic review of 240 articles, esophageal injury corresponded to 0.2% of complications of ACF surgery [ 8 ]. In our service, the rate of esophageal injury was 0.24%.…”

Section: Discussionmentioning

confidence: 99%

Primary Repair of Esophageal Perforation Following Anterior Cervical Fusion

Dantas

Mendes

et al. 2020

Cureus

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Anterior cervical fusion has been performed safely and effectively for decades for the treatment of multiple pathologies, with low rates of morbidity and mortality. Esophageal perforation is a rare but potentially serious complication of anterior cervical spine approaches. There is no consensus regarding the best treatment strategies for this complication. Objectives To determine the prevalence of esophageal perforation following anterior cervical fusion in a single institution and to describe two cases of this complication that were treated with primary repair. Methods We retrospectively analyzed all consecutive patients who underwent anterior cervical fusion in a single private institution from January 1999 to August 2017. Patients who developed esophageal perforation per-or postoperatively were included in the analysis. Results A total of 830 anterior cervical fusion surgeries were performed during the analyzed period. Two cases (0.24%), both of male patients, were complicated by esophageal perforation, one intraoperatively and the other four years after the first surgery. Both patients were treated with primary esophageal repair, and good outcomes were obtained. Conclusion Primary repair is a therapeutic option in cases of esophageal perforation after anterior cervical fusion. Satisfactory results were obtained in both cases. Further studies are necessary to elucidate the best therapeutic options for this rare complication.

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“…Esophageal perforation by spinal hardware after anterior cervical spine surgery is rare, but a significant complication with an estimated incidence of 0.2%–1.15%. 1 , 2 Esophageal perforation secondary to posterior approach seems even rarer and only sporadic cases exist in literature. 3 An 81-year-old man presented to the hospital with hematemesis and epistaxis.…”

Section: Case Reportmentioning

confidence: 99%