Anterior Cervical Discectomy and Fusion

Mayo, Benjamin C.; Massel, Dustin H.; Bohl, Daniel D.; Long, William W.; Modi, Krishna; Singh, Kern

doi:10.1097/brs.0000000000001588

Cited by 39 publications

(30 citation statements)

References 18 publications

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“…Several studies have suggested that the use of operative time may be an alternative measure of surgeon quality in various surgical specialties. 17 , 19 , 37 , 38 The results of the present study support the hypothesis that shorter operative times may also provide an alternative assessment of surgical skills and outcomes. It has been suggested that once the “learning curve” of a procedure has been traversed by newer, lesser experienced trainees for complex cases, the annual volume may not be significantly associated with outcome.…”

Section: Discussionsupporting

confidence: 81%

Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

Phan

Kim

Capua

et al. 2017

Global Spine Journal

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Study Design:Retrospective analysis of prospectively collected data.Objective:There is a paucity of data on the effect of operative duration on postoperative complications during adult spinal deformity surgery (ASDS). The study attempts to explore and quantify the association between increased operation times and postoperative complications.Methods:A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing ASDS were separated into cohorts based on quartiles of operation duration. Chi-square and multivariate logistic regression models were used to identify risk factors.Results:A total of 5338 patients met the inclusion criteria and were divided per quartiles based on operative duration in minutes (154, 235, 346, and 1156 minutes). Multivariate logistic regressions revealed that in comparison to the lowest quartile of operative duration, the highest quartile group was associated significantly with length of stay ≥5 days (odds ratio [OR] = 5.85), any complication (OR = 9.88), wound complication (OR = 5.95), pulmonary complication (OR = 2.85, P = .001), venous thromboembolism (OR = 12.37), intra-/postoperative transfusion (OR = 12.77), sepsis (OR = 5.27), reoperations (OR = 1.48), and unplanned readmissions (OR = 1.29). The odds ratio was higher when comparing a higher quartile group with the reference group across all associations. P < .001 unless otherwise noted.Conclusion:ASDS operation time is associated with multiple postoperative complications, including, but not limited to, wound and pulmonary complications, venous thromboembolism, postoperative transfusion, length of stay ≥5 days, sepsis, reoperation, and unplanned readmission.

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Section: Discussionsupporting

confidence: 81%

Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

Phan

Kim

Capua

et al. 2017

Global Spine Journal

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“…[ 10 ] In several literatures, the reduction of EBL is also a factor in determining the learning curve. [ 11 , 15 , 16 ] Moreover, the volume of transfused RBC were decreased by 30.8% (394.0 mL) in the current study. However, the difference was not statistically significant in our study.…”

Section: Discussionmentioning

confidence: 44%

Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience

et al. 2018

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The purpose of this study was to estimate and analyze the radiological, surgical, and clinical results of posterior vertebral column resection (PVCR) according to the surgeon's experience. Although PVCR has been recognized as the most powerful surgical technique to correct severe spinal deformity, PVCR is a technically demanding procedure with a high complication rate. A retrospective review of the chart and radiographic data of 34 consecutive patients who received PVCR was carried out. According to the time period, the former and latter 17 patients were divided into group 1 and group 2, respectively. Patients’ demographics, surgical, radiological/clinical outcomes, and complications were compared between the groups. The demographic data of the patients had no significant difference between the groups. The surgical time (492.5 ± 164.8 vs 350.5 ± 133.9 minutes, P = .010), estimated blood loss (1294.1 ± 711.9 vs 974.1 ± 905.9 mL, P = .045), and length of hospital stay (22.8 ± 12.9 vs 13.4 ± 3.9 days, P = .017) were significantly reduced in group 2. The correction of the PVCR site (40.5° ± 13.3° vs 41.2° ± 23.7°, P = .909), sagittal vertical axis (SVA, 81.9 ± 7.2 mm vs 77.9 ± 102.0 mm, P = .904) were not different between the groups. The total number of complications (22 vs 10, P = .031) and patients having complications (13 vs 7, P = .039) were lower in group 2. Additional surgery was significantly lower in group 2 (13 vs 3, P = .007). The clinical outcomes by revised Scoliosis Research Society-22 (SRS-22r) questionnaire were not different between the groups. Our series revealed that the complications after PVCR may reduce from 17 cases and surgical outcomes might be stabilized by 29 cases.

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“…The 59 articles included in this review are listed in Table 1 . 6 – 65 Data collection, analysis, and manuscript preparation followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Figure 1 ). 66 …”

Section: Methodsmentioning

confidence: 99%

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Oshina

Oshima

Tanaka

et al. 2018

Global Spine Journal

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Study Design:Systematic review.Objectives:Diagnosis of pseudarthrosis after anterior cervical fusion is difficult, and often depends on the surgeon’s subjective assessment because recommended radiographic criteria are lacking. This review evaluated the available evidence for confirming fusion after anterior cervical surgery.Methods:Articles describing assessment of anterior cervical fusion were retrieved from MEDLINE and SCOPUS. The assessment methods and fusion rates at 1 and 2 years were evaluated to identify reliable radiographical criteria.Results:Ten fusion criteria were described. The 4 most common were presence of bridging trabecular bone between the endplates, absence of a radiolucent gap between the graft and endplate, absence of or minimal motion between adjacent vertebral bodies on flexion-extension radiographs, and absence of or minimal motion between the spinous processes on flexion-extension radiographs. The mean fusion rates were 90.2% at 1 year and 94.7% at 2 years. The fusion rate at 2 years had significant independence (P = .048).Conclusions:The most common fusion criteria, bridging trabecular bone between the endplates and absence of a radiolucent gap between the graft and endplate, are subjective. We recommend using <1 mm of motion between spinous processes on extension and flexion to confirm fusion.

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Anterior Cervical Discectomy and Fusion

Abstract: 4.

Cited by 39 publications

References 18 publications

Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

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