Frequency and Acceptability of Adverse Events After Anterior Cervical Discectomy and Fusion

Wilson, Jefferson R.; Radcliff, Kris E.; Schroeder, Gregory D.; Booth, Madison; Lucasti, Christopher; Fehlings, Michael G.; Nassr, Ahmad; Vaccaro, Alexander R.; Arnold, Paul M.; Sciubba, Daniel M.; Ching, Alexander C.; Smith, Justin S.; Shaffrey, Christopher I.; Singh, Kern; Darden, Bruce V.; Daffner, Scott D.; Cheng, Ivan; Ghogawala, Zoher; Ludwig, Steven C.; Buchowski, Jacob M.; Brodke, Darrel S.; Wang, Jeffrey; Lehman, Ronald A.; Hilibrand, Alan S.; Yoon, Tim; Grauer, Jonathan N.; Dailey, Andrew T.; Steinmetz, Michael P.

doi:10.1097/bsd.0000000000000645

Cited by 3 publications

(6 citation statements)

References 25 publications

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“…ACDF has been used since the 1950s and is currently accepted as the standard approach. 1,3 However, ACDF is known to be associated with some distinct early and late complications. The early complications include neurologic deterioration, dysphagia, esophageal perforation, hoarseness, vascular injury, and postoperative hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…The early complications include neurologic deterioration, dysphagia, esophageal perforation, hoarseness, vascular injury, and postoperative hematoma. 2,3,9 Hoarseness largely results from edema and intubation; however, a small percentage of patients may develop permanent hoarseness due to recurrent laryngeal nerve injury. In a large case-series report by Flynn, the incidence of permanent recurrent laryngeal nerve injury was 2%.…”

Section: Discussionmentioning

confidence: 99%

“…Although dysphagia tends to improve over several days, persistent dysphagia is an important problem that impairs quality of life. 2,3,11 Implants used during ACDF are a major cause of late complications. The most common ones include subsidence, dislocation, or failure of fusion of the cage or graft placed in the intervertebral disk space.…”

Section: Discussionmentioning

confidence: 99%

“…1 However, this method may lead to long-term sequelae such as dysphagia, recurrent laryngeal nerve injury, and delayed bone fusion. 2,3 The typical complications of ACDF include graft-related problems, pseudoarthrosis, adjacent-segment disease (ASD), fusion failure, and limited cervical range of motion. [4][5][6][7] Posterior keyhole laminoforaminotomy was developed to prevent delayed bone fusion and adjacent-segment disease.…”

Section: Introductionmentioning

confidence: 99%

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Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation

Karaoğlu

Polat

Uçkun

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Objective To evaluate the clinicoradiologic conditions of patients with a herniated cervical disk who were treated with percutaneous endoscope-assisted cervical diskectomy. Materials and Methods The medical data of 27 patients (16 men and 11 women; mean age: 40.9 years) who were operated on with the posterior endoscope-assisted cervical diskectomy method were reviewed retrospectively. The mean follow-up was 35.1 months, and the patients were assessed with combined preoperative and postoperative visual analog scale (VAS), Prolo Functional Economic Outcome Rating scale, MacNab scale, and clinical imaging. Results The mean preoperative VAS level was 8.6 (range: 7–10), and mean Prolo score was 2.5 (range: 2–5). A postoperative assessment performed 1 week postsurgery found a mean VAS level of 2.1 (range: 0–4). At the final examination, the mean VAS level was 0.81 (range: 0–3), and the mean Prolo score was 4.5 (range: 3–5). The final MacNab scale scores were 62.9%, excellent; 25.9%, good; 7.4%, moderate; and 3.7%, poor. Conclusion Percutaneous endoscope-assisted cervical diskectomy is a suitable and effective treatment method for soft cervical disk herniation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation

Karaoğlu

Polat

Uçkun

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…[3][4][5] One of the most undesirable complications that can occur after surgery for DCM is postoperative neurological deterioration, which can leave patients with unexpected and sometimes profound new functional deficits. 6 Presentations range from catastrophic intraoperative spinal cord injury, which is clearly devastating but fortunately rare, to delayed C5 nerve root palsy, which can be disabling but is considered common with a generally favorable prognosis. 6 The incidence, etiology, and outcomes of patients who experience neurological deterioration after surgery for DCM are poorly understood, and further research is needed to confidently inform patients, surgeons, researchers, and other evidence users.…”

mentioning

confidence: 99%

Deterioration After Surgery for Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network

Evaniew

Burger

Dea

et al. 2022

Spine

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Study Design. A Prospective cohort study. Objective. To investigate the incidence, etiology, and outcomes of patients who experience neurological deterioration after surgery for Degenerative Cervical Myelopathy (DCM).Summary of Background Data. Postoperative neurological deterioration is one of the most undesirable complications that can occur after surgery for DCM. Methods. We analyzed data from the Canadian Spine Outcomes and Research Network DCM prospective cohort study. We defined postoperative neurological deterioration as any decrease in modified Japanese Orthopaedic Association (mJOA) score by at least one point from baseline to three months after surgery. Adverse events were collected using the Spinal Adverse Events Severity protocol. Secondary outcomes included patient-reported pain, disability, and health-related quality of life.Results. Among a study cohort of 428 patients, 50 (12%) deteriorated by at least one mJOA point after surgery for DCM (21 by one point, 15 by two points, and 14 by three points or more). Significant risk factors included older age, female sex, and milder disease. Among those who deteriorated, 13 experienced contributing intraoperative or postoperative adverse events, six had alternative non-DCM diagnoses, and 31 did not have an identifiable reason for deterioration. Patients who deteriorated had significantly lower mJOA scores at one year after surgery [13.5 (SD 2.7) vs. 15.2 (SD 2.2), P < 0.01 and those with larger deteriorations were less likely to recover their mJOA to at least their preoperative baseline, but most secondary measures of pain, disability, and health-related quality of life were unaffected. Conclusions. The incidence of deterioration of mJOA scores after surgery for DCM was approximately one in 10, but some deteriorations were unrelated to actual spinal cord impairment and most secondary outcomes were unaffected. These findings can inform patient and surgeon expectations during shared decision-making, and they demonstrate that the interpretation of mJOA scores without clinical context can sometimes be misleading.

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CORR Insights®: Minimum Clinically Important Differences of the Hospital for Special Surgery Dysphagia and Dysphonia Inventory and Other Dysphagia Measurements in Patients Undergoing ACDF

Lavelle

2020

Clin Orthop Relat Res

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Frequency and Acceptability of Adverse Events After Anterior Cervical Discectomy and Fusion

Abstract: These results serve to aid communication and transparency within the field of spine surgery, and will help to inform future quality improvement and best practice initiatives.

Cited by 3 publications

References 25 publications

Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation

Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation

Deterioration After Surgery for Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network

CORR Insights®: Minimum Clinically Important Differences of the Hospital for Special Surgery Dysphagia and Dysphonia Inventory and Other Dysphagia Measurements in Patients Undergoing ACDF

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