A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

Abstract

Background: There are multiple complications reported for anterior cervical diskectomy and fusion (ACDF), one of the most common cervical spine operations performed in the US (e.g. estimated at 137,000 ACDF/year). Methods: Multiple studies analyzed the risks and complications rates attributed to ACDF. Results: In multiple studies, overall morbidity rates for ACDF varied from 13.2% to 19.3%. These included in descending order; dysphagia (1.7%-9.5%), postoperative hematoma (0.4%-5.6% (surgery required in 2.4% of 5.6%), with epidural hematoma 0.9%), exacerbation of myelopathy (0.2%-3.3%), symptomatic recurrent laryngeal nerve palsy (0.9%-3.1%), cerebrospinal fluid (CSF) leak (0.5%-1.7%), wound infection (0.1-0.9%-1.6%), increased radiculopathy (1.3%), Horner’s syndrome (0.06%-1.1%), respiratory insufficiency (1.1%), esophageal perforation (0.3%-0.9%, with a mortality rate of 0.1%), and instrument failure (0.1%-0.9%). There were just single case reports of an internal jugular veing occlusion and a phrenic nerve injury. Pseudarthrosis occurred in ACDF and was dependant on the number of levels fused; 0-4.3% (1-level), 24% (2-level), 42% (3 level) to 56% (4 levels). The reoperation rate for symptomatic pseudarthrosis was 11.1%. Readmission rates for ACDF ranged from 5.1% (30 days) to 7.7% (90 days postoperatively). Conclusions: Complications attributed to ACDF included; dysphagia, hematoma, worsening myelopathy, recurrent laryngeal nerve palsy, CSF leaks, wound infection, radiculopathy, Horner’s Syndrome, respiratory insufficiency, esophageal perforation, and instrument failure. There were just single case reports of an internal jugular vein thrombosis, and a phrenic nerve injury. As anticipated, pseudarthrosis rates increased with the number of ACDF levels, ranging from 0-4.3% for 1 level up to 56% for 4 level fusions.

The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results

“…[17][18][19] Unfavorable postoperative complications such as pseudoarthrosis and adjacent segment disease have been reported. 20 Posterior cervical foraminotomy (PCF) gained popularity as an alternative to ACDF, sparing problems associated with fusion and surgical instrumentations. Compared to the anterior cervical approach, the posterior cervical approach technique has significant advantages, such as no vital organ damage in the anterior neck, preservation of a cervical range of motion, and no complications caused by a bone graft.…”

Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

“…While anterior based procedures such as ACDF and ADR had demonstrated good clinical outcomes, these procedures sacrifice the intervertebral disc in order to achieve their objective of decompression. Invariably affecting cervical motion and increased risk of adjacent segment degeneration, pseudo arthrosis on top of the approach related complications [4,20]. In our described technique, we only removed the prolapsed part of the disc while preserving the majority of the cervical intervertebral disc.…”

“…However, it involves sacrificing an intervertebral disc in the process of increasing the foraminal height and decompressing the foramen. Adjacent segment disease and pseudoarthrosis and being the commonest postoperative complications of anterior cervical surgery with an overall complication rate of anterior cervical surgery ranges from 13.2 to 19.3% [4]. Posterior cervical foraminotomy (PCF) has the advantage of motion preservation from conservation of the intervertebral disc and is a popular alternative to ACDF and ADR with good clinical results [5][6][7].…”

Safety for cervical corpectomy and diskectomy: univariate and multivariate analysis on predictors for prolonged ICU stay after anterior spinal fusion

“…3 The rate of postoperative hematoma requiring re-operations ranging from 2.4% to 5.6%. 4 For the airway management after anterior cervical spine surgery, in general, operating surgeons preferred direct extubation in the operating theatre. On the other hand, some of these patients were kept intubated after the operations and transferred to the ICU as determined by the anaesthetists.…”