Anterior cervical discectomy and fusion associated complications

Kostas N. Fountas, Eftychia Z. Kapsalaki, Leonidas G. Nikolakakos, Hugh F. Smisson, Kim W. Johnston, Arthur A. Grigorian, Gregory P Lee, Joe S. Robinson

Research output: Contribution to journalReview article

470 Citations (Scopus)

Abstract

STUDY DESIGN. Retrospective review study with literature review. OBJECTIVE. The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management. SUMMARY OF BACKGROUND DATA. It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable. METHODS. In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months. RESULTS. The mortality rate in our current series was 0.1% (1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3% (196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5% of our patients. Postoperative hematoma occurred in 5.6%, but required surgical intervention in only 2.4% of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1% of our cases. Dural penetration occurred in 0.5%, esophageal perforation in 0.3%, worsening of preexisting myelopathy in 0.2%, Horner's syndrome in 0.1%, instrumentation backout in 0.1%, and superficial wound infection in 0.1% of our cases. CONCLUSION. Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.

Original languageEnglish (US)
Pages (from-to)2310-2317
Number of pages8
JournalSpine
Volume32
Issue number21
DOIs
StatePublished - Oct 1 2007

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Diskectomy
Esophageal Perforation
Vocal Cord Paralysis
Spinal Cord Diseases
Deglutition Disorders
Hematoma
Retrospective Studies
Hospital Outpatient Clinics
Horner Syndrome
Spondylosis
Radiculopathy
Wound Infection
Allografts
Morbidity
Mortality
Incidence

Keywords

  • Anterior
  • Cervical
  • Complication
  • Discectomy
  • Dysphagia
  • Hematoma
  • Recurrent laryngeal nerve palsy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Fountas, K. N., Kapsalaki, E. Z., Nikolakakos, L. G., Smisson, H. F., Johnston, K. W., Grigorian, A. A., ... Robinson, J. S. (2007). Anterior cervical discectomy and fusion associated complications. Spine, 32(21), 2310-2317. https://doi.org/10.1097/BRS.0b013e318154c57e

Anterior cervical discectomy and fusion associated complications. / Fountas, Kostas N.; Kapsalaki, Eftychia Z.; Nikolakakos, Leonidas G.; Smisson, Hugh F.; Johnston, Kim W.; Grigorian, Arthur A.; Lee, Gregory P; Robinson, Joe S.

In: Spine, Vol. 32, No. 21, 01.10.2007, p. 2310-2317.

Research output: Contribution to journalReview article

Fountas, KN, Kapsalaki, EZ, Nikolakakos, LG, Smisson, HF, Johnston, KW, Grigorian, AA, Lee, GP & Robinson, JS 2007, 'Anterior cervical discectomy and fusion associated complications', Spine, vol. 32, no. 21, pp. 2310-2317. https://doi.org/10.1097/BRS.0b013e318154c57e
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA et al. Anterior cervical discectomy and fusion associated complications. Spine. 2007 Oct 1;32(21):2310-2317. https://doi.org/10.1097/BRS.0b013e318154c57e
Fountas, Kostas N. ; Kapsalaki, Eftychia Z. ; Nikolakakos, Leonidas G. ; Smisson, Hugh F. ; Johnston, Kim W. ; Grigorian, Arthur A. ; Lee, Gregory P ; Robinson, Joe S. / Anterior cervical discectomy and fusion associated complications. In: Spine. 2007 ; Vol. 32, No. 21. pp. 2310-2317.
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abstract = "STUDY DESIGN. Retrospective review study with literature review. OBJECTIVE. The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management. SUMMARY OF BACKGROUND DATA. It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable. METHODS. In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months. RESULTS. The mortality rate in our current series was 0.1{\%} (1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3{\%} (196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5{\%} of our patients. Postoperative hematoma occurred in 5.6{\%}, but required surgical intervention in only 2.4{\%} of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1{\%} of our cases. Dural penetration occurred in 0.5{\%}, esophageal perforation in 0.3{\%}, worsening of preexisting myelopathy in 0.2{\%}, Horner's syndrome in 0.1{\%}, instrumentation backout in 0.1{\%}, and superficial wound infection in 0.1{\%} of our cases. CONCLUSION. Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.",
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AU - Fountas, Kostas N.

AU - Kapsalaki, Eftychia Z.

AU - Nikolakakos, Leonidas G.

AU - Smisson, Hugh F.

AU - Johnston, Kim W.

AU - Grigorian, Arthur A.

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AU - Robinson, Joe S.

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N2 - STUDY DESIGN. Retrospective review study with literature review. OBJECTIVE. The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management. SUMMARY OF BACKGROUND DATA. It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable. METHODS. In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months. RESULTS. The mortality rate in our current series was 0.1% (1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3% (196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5% of our patients. Postoperative hematoma occurred in 5.6%, but required surgical intervention in only 2.4% of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1% of our cases. Dural penetration occurred in 0.5%, esophageal perforation in 0.3%, worsening of preexisting myelopathy in 0.2%, Horner's syndrome in 0.1%, instrumentation backout in 0.1%, and superficial wound infection in 0.1% of our cases. CONCLUSION. Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.

AB - STUDY DESIGN. Retrospective review study with literature review. OBJECTIVE. The goal of our current study is to raise awareness on complications associated with anterior cervical discectomy and fusion (ACDF) and their early detection and proper management. SUMMARY OF BACKGROUND DATA. It is known that ACDF constitutes one of the most commonly performed spinal procedures. Its outcome is quite satisfactory in the majority of cases. However, occasional complications can become troublesome, and in rare circumstances, catastrophic. Although there are several case reports describing such complications, their rate of occurrence is generally underreported, and data regarding their exact incidence in large clinical series are lacking. Meticulous knowledge of potential intraoperative and postoperative ACDF-related complications is of paramount importance so as to avoid them whenever possible, as well as to successfully and safely manage them when they are inevitable. METHODS. In a retrospective study, 1015 patients undergoing first-time ACDF for cervical radiculopathy and/or myelopathy due to degenerative disc disease and/or cervical spondylosis were evaluated. A standard Smith-Robinson approach was used in all our patients, while an autologous or allograft was used, with or without a plate. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed for procedure-related complications. Mean follow-up time was 26.4 months. RESULTS. The mortality rate in our current series was 0.1% (1 of 1015 patients, death occurred secondary to an esophageal perforation). Our overall morbidity rate was 19.3% (196 of 1015 patients). The most common complication was the development of isolated postoperative dysphagia, which observed in 9.5% of our patients. Postoperative hematoma occurred in 5.6%, but required surgical intervention in only 2.4% of our cases. Symptomatic recurrent laryngeal nerve palsy occurred in 3.1% of our cases. Dural penetration occurred in 0.5%, esophageal perforation in 0.3%, worsening of preexisting myelopathy in 0.2%, Horner's syndrome in 0.1%, instrumentation backout in 0.1%, and superficial wound infection in 0.1% of our cases. CONCLUSION. Meticulous knowledge of the ACDF-associated complications allows for their proper management. Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy were the most common complications in our series. Management of complications was successful in the vast majority of our cases.

KW - Anterior

KW - Cervical

KW - Complication

KW - Discectomy

KW - Dysphagia

KW - Hematoma

KW - Recurrent laryngeal nerve palsy

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