Perioperative complications in patients treated with posterior cervical fusion and bilateral cages

Abstract

Context:Posterior cervical cages have recently become available as an alternative to lateral mass fixation in patients undergoing cervical spine surgery.Aims:The purpose of this study was to quantify the perioperative complications associated with cervical decompression and fusion in patients treated with a posterior cervical fusion (PCF) and bilateral cages.Settings and Design:A retrospective, multicenter review of prospectively collected data was performed at 11 US centers.Subjects and Methods:The charts of 89 consecutive patients with cervical radiculopathy treated surgically at one level with PCF and cages were reviewed. Three cohorts of patients were included standalone primary PCF with cages, circumferential surgery, and patients with postanterior cervical discectomy and fusion pseudarthrosis. Follow-up evaluation included clinical status and pain scale (visual analog scale).Statistical Analysis Used:The Wilcoxon test was used to test the differences for the data. The P level of 0.05 was considered significant.Results:The mean follow-up interval was 7 months (range: 62 weeks - 2 years). The overall postsurgery complication rate was 4.3%. There were two patients with neurological complications (C5 palsy, spinal cord irritation). Two patients had postoperative complications after discharge including one with atrial fibrillation and one with a parietal stroke. After accounting for relatedness to the PCF, the overall complication rate was 3.4%. The average (median) hospital stay for all three groups was 29 h.Conclusions:The results of our study show that PCF with cages can be considered a safe alternative for patients undergoing cervical spine surgery. The procedure has a favorable overall complication profile, short length of stay, and negligible blood loss.

Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature

“…13 The mean LOS across our entire systematic review ranged from 26 to 33.6 hours [13][14][15]17 and suggests a significant improvement on traditional posterior cervical fusion, which ranges from 4.0 to 7.3 days. [21][22][23][24][25][26][27][28] Additionally, the mean EBL in this review ranged from 32.83 to 87.8 cm 3 for the tissue-sparing, posterior interfacet fusion, [13][14][15]17 which compares favorably to open posterior cervical fusions (range, 225-480 cm 3 ). [21][22][23][24][25][26][27][28]…”

“…After systematic review, a total of seven studies met inclusion criteria (Figure 1). 8,[12][13][14][15][16][17] All studies were classified as either retrospective cohort or prospective cohort. There were no studies with a control or comparison group.…”

“…17 The remaining studies reported decreased VAS neck pain by 4.9 to 5.0 points and a decreased VAS arm pain of 4.8 points. [14][15][16] Overall, the literature suggests that posterior cervical cage placement results in decreased pain at all time points after surgery. Moreover, all included studies well-exceeded the previously described MCID criteria for VAS of 3 points or greater.…”

“…14 One study focused on the evaluation of perioperative complications within 30 days of surgery. 15 The authors reported 3 complications related to posterior cervical fusion with cages (3.4%), which included a patient developing atrial fibrillation postoperatively and another patient with a parietal stroke during the procedure. There were no patients who suffered an inadvertent durotomy, neurologic injury, infection, implant migration, vertebral artery injury or reoperation.…”

Fusion with posterior cervical cages for single level radiculopathy, a review of the literature

“…Siemionow et. al investigated complications of 89 patients including primary PCC, PCC combined with ACDF and revision of pseudoarthrosis after ACDF with PCC with a mean 7-month follow-up [31]. The overall complication rate related to PCC surgery was 3,4%, which the authors reported was favorable when compared to anterior only approaches for single level cervical radiculopathy.…”