???Normal??? Prevertebral Soft Tissue Swelling Following Elective Anterior Cervical Decompression and Fusion

Sanfilippo, James A.; Lim, Moe R.; Jacoby, Sidney M.; LaTerra, Robert; Harrop, James S.; Vaccaro, Alexander R.; Hilibrand, Alan S.; Anderson, D. Greg; Albert, Todd J.

doi:10.1097/00024720-200608000-00004

Cited by 21 publications

(26 citation statements)

References 12 publications

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“…7 Prevertebral soft-tissue thickness was determined by measuring the thickness of soft tissue from the anterior aspect of C3-7 vertebral bodies to the posterior aspect of the trachea. 1,35,42 Magnification effects were corrected for by using the Zero-P implant as a standard reference. Radiographic fusion was defined by the presence of bony bridging across the intervertebral space on CT imaging or as less than 4° of motion on dynamic radiographs.…”

Section: Radiological Evaluationmentioning

confidence: 99%

“…Edema of the prevertebral soft tissue is routinely observed after ACDF. 35 A study by Suk et al identified the natural course of prevertebral soft-tissue swelling in the immediate postoperative period, with peak swelling noted at postoperative Day 2 or 3 and a gradual decrease starting at postoperative Day 4. 42 A retrospective study of 100 patients who underwent ACDF compared prevertebral soft-tissue measurements from preoperation, 2 weeks postoperation, and 6 weeks postoperation.…”

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confidence: 99%

“…It was found that the majority of prevertebral swelling resolves by 6 weeks after surgery. 35 Given the incidence and course of postoperative prevertebral soft-tissue swelling, it has been hypothesized that it contributes to dysphagia following ACDF. Interestingly, when we investigated the relationship between degree of postoperative prevertebral soft-tissue thickness and dysphagia at both early and later time points after surgery in our cohort, we did not find any significant correlation.…”

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confidence: 99%

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Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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Object Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. Methods Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well. Results Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2–19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0–10) to 0 (range 0–8; p < 0.001). The arm VAS score improved from a median of 2 (range 0–10) to 0 (range 0–7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0–3) immediately postoperatively to 0 (range 0–2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Conclusions A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.

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Section: Radiological Evaluationmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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“…[1][2][3] Andrew and Sidhu [1] measured PSTS across all cervical vertebrae from C2 till the T1 level. One measurement was made at C2 and three measurements were made per cervical vertebra in the subaxial spine at the level of the superior end plate, mid body and inferior end plate.…”

Section: Discussionmentioning

confidence: 99%

Temporal progression and spatial distribution of "normal" prevertebral soft tissue swelling following central corpectomy for cervical spondylotic myelopathy

2012

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“…Plain radiographs are not helpful in determining whether a patient may be extubated because significant prevertebral swelling may be present in asymptomatic patients following anterior cervical spinal surgery. 2,48 Inspection of the upper airway should reveal an absence of edema. The performance of a cuff leak test is an important part of the process and at this time a 200-ml leak is considered the minimal amount to extubate.…”

Section: Discussionmentioning

confidence: 99%

Total subaxial reconstruction

Traynelis¹

2010

SPI

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Object. Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery.Methods. The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression.Results. There were 16 men and 11 women whose mean age was 59 years (range 35-86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2-7 surgery, and in all others the procedure crossed the cervicothoracic junction.Following surgery patients remained intubated for an average of 3.3 days (range 1-22 days). The mean hospital length of stay was 11 days (range 3-45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre-and postoperative visual analog scale neck pain scores were 6.0 and 2

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???Normal??? Prevertebral Soft Tissue Swelling Following Elective Anterior Cervical Decompression and Fusion

Abstract: The "normal" range for PSTS at 2 weeks and at 6 weeks after elective 1- and 2- level anterior cervical decompression and fusions is described. Our data demonstrates that edema persists at the 2-week follow-up. By 6 weeks postoperative, the increased PSTS has greatly dissipated.

Cited by 21 publications

References 12 publications

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Temporal progression and spatial distribution of "normal" prevertebral soft tissue swelling following central corpectomy for cervical spondylotic myelopathy

Total subaxial reconstruction

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