Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study

Lee, Michael J.; Bazaz, Raj; Furey, Christopher G.; Yoo, Jung U.

doi:10.1016/j.spinee.2006.02.024

Cited by 230 publications

(217 citation statements)

References 7 publications

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“…In all our cases, dysphagia was transient and required no special treatment. Although most studies reported that dysphagia decreases with time, the prevalence of chronic dysphagia is more common than previously considered (73,(78)(79)(80).…”

Section: Dysphagiamentioning

confidence: 85%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Section: Dysphagiamentioning

confidence: 85%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

View full text Add to dashboard Cite

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“…The current study largely reflected the rate of common complications observed with plated ACDFP [21,42,66,77]. We had no neurologic deficits, cervical or iliac crest infections, RLN palsy or occult instabilities [21,59,64,75,77,82].…”

Section: Complicationsmentioning

confidence: 86%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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“…22 Overall, 7%-15% of ACDF cases will need revision surgery, 3,11,21,22,27 which is associated with greater complications and risk and is technically more challenging. 24 The extent to which alterations of adjacent-level biomechanics and intradiscal pressures accelerate the normal degenerative process remains unclear at this time. [12][13][14]20,26,[28][29][30][31]34,40 Fusing a level adjacent to a prior ACDF often calls for exposing and removing the previously placed plate and screws.…”

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confidence: 99%

Zero-profile hybrid fusion construct versus 2-level plate fixation to treat adjacent-level disease in the cervical spine

Healy

Sundar

Cardenas³

et al. 2014

SPI

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Object Single-level anterior cervical discectomy and fusion (ACDF) is an established surgical treatment for cervical myelopathy. Within 10 years of undergoing ACDF, 19.2% of patients develop symptomatic adjacent-level degeneration. Performing ACDF adjacent to prior fusion requires exposure and removal of previously placed hardware, which may increase the risk of adverse outcomes. Zero-profile cervical implants combine an interbody spacer with an anterior plate into a single device that does not extend beyond the intervertebral disc space, potentially obviating the need to remove prior hardware. This study compared the biomechanical stability and adjacent-level range of motion (ROM) following placement of a zero-profile device (ZPD) adjacent to a single-level ACDF against a standard 2-level ACDF. Methods In this in vitro biomechanical cadaveric study, multidirectional flexibility testing was performed by a robotic spine system that simulates flexion-extension, lateral bending, and axial rotation by applying a continuous pure moment load. Testing conditions were as follows: 1) intact, 2) C5–6 ACDF, 3) C4–5 ZPD supraadjacent to simulated fusion at C5–6, and 4) 2-level ACDF (C4–6). The sequence of the latter 2 test conditions was randomized. An unconstrained pure moment of 1.5 Nm with a 40-N simulated head weight load was applied to the intact condition first in all 3 planes of motion and then using the hybrid test protocol, overall intact kinematics were replicated subsequently for each surgical test condition. Intersegmental rotations were measured optoelectronically. Mean segmental ROM for operated levels and adjacent levels was recorded and normalized to the intact condition and expressed as a percent change from intact. A repeated-measures ANOVA was used to analyze the ROM between test conditions with a 95% level of significance. Results No statistically significant differences in immediate construct stability were found between construct Patterns 3 and 4, in all planes of motion (p > 0.05). At the operated level, C4–5, the zero-profile construct showed greater decreases in axial rotation (–45% vs –36%) and lateral bending (–55% vs –38%), whereas the 2-level ACDF showed greater decreases in flexion-extension (–40% vs –34%). These differences were marginal and not statistically significant. Adjacent-level motion was nearly equivalent, with minor differences in flexion-extension. Conclusions When treating degeneration adjacent to a single-level ACDF, a zero-profile implant showed stabilizing potential at the operated level statistically similar to that of the standard revision with a 2-level plate. Revision for adjacent-level disease is common, and using a ZPD in this setting should be investigated clinically because it may be a faster, safer alternative.

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Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study

Cited by 230 publications

References 7 publications

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Zero-profile hybrid fusion construct versus 2-level plate fixation to treat adjacent-level disease in the cervical spine

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